Quality Assurance Analyst
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AI Summary
The QC Analyst conducts internal and external audits of claim examiners to ensure adherence to company policies and regulatory requirements. They also collaborate with cross-functional teams to optimize audit workflows and enhance organizational compliance processes.
Raphael & Associates is a globally recognized third-party claims administrator and independent claims adjusting firm, known for delivering exceptional service. We understand the importance of staying agile in a dynamic market and pride ourselves on tailoring our solutions to meet the unique needs of each client. While the work we do as a claims organization is complex, our mission is clear: to deliver outstanding service, attract and retain top-tier professionals, and leverage industry-leading technology to drive results.
Join Our Team
As a leader in the industry, we offer dynamic and rewarding career opportunities for individuals who are driven to make an impact. Our culture is built on collaboration, innovation, and a shared commitment to excellence. We value professionals who bring creativity, vision, and a proactive, results-oriented mindset.
We are seeking experienced, motivated, and forward-thinking individuals to join our team and contribute to our continued success.
The Opportunity
The QC Analyst supports quality assurance, compliance, and continuous improvement efforts by conducting internal audits, supporting external audit activities, and helping enhance auditing systems and processes.
Key Responsibilities
We are an organization that values and recognizes the contributions of our team members. We offer competitive compensation and benefits package commensurate with experience, including base salary, performance-based incentives, paid time off, comprehensive medical, dental, vision, and life insurance, as well as a 401(k) plan with company matching.
Raphael & Associates is an Equal Opportunity Employer. We are committed to building an equitable, collaborative and diverse workforce throughout our organization by providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other legally protected characteristic. This policy extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, terminations, promoting, transferring, compensation, benefits, training, leave of absence, and other terms, conditions, and benefits of employment.
The above is intended to describe this job's general requirements. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Join Our Team
As a leader in the industry, we offer dynamic and rewarding career opportunities for individuals who are driven to make an impact. Our culture is built on collaboration, innovation, and a shared commitment to excellence. We value professionals who bring creativity, vision, and a proactive, results-oriented mindset.
We are seeking experienced, motivated, and forward-thinking individuals to join our team and contribute to our continued success.
The Opportunity
The QC Analyst supports quality assurance, compliance, and continuous improvement efforts by conducting internal audits, supporting external audit activities, and helping enhance auditing systems and processes.
Key Responsibilities
- Support the ongoing development, maintenance, and enhancement of the organization’s internal auditing platform, including identifying system improvements, testing updates, and optimizing audit workflows.
- Conduct comprehensive audits of claim examiners to evaluate adherence to company policies, quality standards, and applicable regulatory requirements, while identifying areas of risk and opportunities for improvement.
- Serve as a primary liaison between clients, third-party vendors, and internal stakeholders to coordinate external audit activities, ensuring timely communication and efficient audit execution.
- Collect, review, organize, and submit audit-related documentation to support external audits, ensuring accuracy, completeness, and compliance with established requirements.
- Collaborate with cross-functional teams to analyze operational processes, identify opportunities for increased efficiency and compliance, and assist in developing and documenting standardized procedures and best practices.
- Partner with Training, Legal, and Human Resources departments on special projects, compliance initiatives, policy implementation efforts, and other organizational priorities to support regulatory and business objectives.
- 10+ years of experience in claims, insurance, quality assurance, and client-facing roles, preferably within a Third-Party Administrator (TPA) environment.
- Bachelor’s degree preferred; equivalent professional experience will be considered.
- Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint).
- Demonstrated experience with internal, client, and regulatory audits, including DOI complaint responses.
- Working knowledge of licensing requirements, Medicare compliance, and other regulatory frameworks.
- Strong organizational skills and exceptional attention to detail.
- Experience with CRM systems and database management.
- Customer-focused mindset with a commitment to high-quality client service.
- Excellent written and verbal communication skills with a professional presence.
- Effective time management skills with a proven ability to meet deadlines and follow through on commitments.
- Collaborative team player with the ability to build strong working relationships.
- Analytical thinker with strong problem-solving skills and adaptability in a fast-paced environment.
We are an organization that values and recognizes the contributions of our team members. We offer competitive compensation and benefits package commensurate with experience, including base salary, performance-based incentives, paid time off, comprehensive medical, dental, vision, and life insurance, as well as a 401(k) plan with company matching.
Raphael & Associates is an Equal Opportunity Employer. We are committed to building an equitable, collaborative and diverse workforce throughout our organization by providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other legally protected characteristic. This policy extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, terminations, promoting, transferring, compensation, benefits, training, leave of absence, and other terms, conditions, and benefits of employment.
The above is intended to describe this job's general requirements. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
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