Highmark · 13 hours ago
Quality Analyst
Erie-Meadville Area
Full-time
Onsite
Mid Level
$22.71/hr - $35.18/hr
3+ years expHighmark Inc. is seeking a Quality Analyst responsible for analyzing data related to complex adjusted claims and ensuring compliance with adjustment processes. The role involves conducting audits, training staff, and recommending process improvements based on findings.
Health CareHealth InsuranceInsuranceWellness
Responsibilities
Ensure the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process
Develop management reports detailing the review process findings as well as trending/analysis reports
Monitor and train quality and operational staff
Identify any potential fraudulent activity relating to adjustment and/or duplicate claim processing and address any and all deficiencies to remain compliant and report non compliant areas
Other duties as assigned or requested
Qualification
Required
High School Diploma/GED
3-5 years of relevant, progressive experience in the area of specialization. Exempted experience requirements effective August 2016
Experience in claims and/or inquiry processing or equivalent experience in quality
Experience with Microsoft Office Products
Detailed understanding of the various claims and inquiry processing arrangements, the related Member Touchpoint Measures (MTM) performance standards, and process improvement methodologies
Working knowledge of various company related benefits, payment policies and procedures, medical terminology, profile mechanisms, and medical policy guidelines
Strong background in both verbal and written communication, interpersonal skills, and organizational, problem solving, analytical, interpretative, evaluative and creative skills and abilities
Proficiency with reporting and analytical software tools and a strong knowledge of systems utilized throughout the company Operations Division
Preferred
Bachelor's Degree
Company
Highmark
Highmark provides health insurance plans for individuals and businesses.
10001+ employees
H1B Sponsorship
Highmark has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (7)
2023 (19)
2022 (21)
2021 (18)
2020 (23)
Funding
Current Stage
Late StageTotal Funding
$27.3M2018-04-06Grant· $25M
2014-08-07Grant· $2.3M
Leadership Team
Deborah Rice-Johnson
CEO, Diversified Businesses at Highmark Inc. and Chief Growth Officer
Paul Sikora
CTO Provider Services
Recent News
2025-12-11
Company data provided by crunchbase