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Qa Claims Jobs (NOW HIRING)

Tarkett

Claims & Quality Specialist

Middlefield, OH

Quality Assurance & Claims Coordinator Middlefield, OH | Hourly / Non-Exempt | Quality Department Reports To: Senior Quality Manager, Ohio Campus Position Summary The Quality Assurance & Claims ...

Tarkett

Claims & Quality Specialist

Middlefield, OH · On-site

Quality Assurance & Claims Coordinator Middlefield, OH | Hourly / Non-Exempt | Quality Department Reports To: Senior Quality Manager, Ohio Campus Position Summary The Quality Assurance & Claims ...

Corvel

Claims Quality Assurance

San Diego, CA · Remote

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary ...

Corvel

Claims Quality Assurance

San Diego, CA · On-site

$70K - $116K/yr

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary ...

MetroPlusHealth

Quality Assurance Analyst

Manhattan, NY · Remote

$85K - $95K/yr

This Quality Assurance Analyst will be responsible for reviewing the Claims Processing Systems for configured benefits and reimbursement methodologies. Experienced candidates must demonstrate working ...

MetroPlusHealth

Quality Assurance Analyst

Manhattan, NY · On-site

$85K - $95K/yr

This Quality Assurance Analyst will be responsible for reviewing the Claims Processing Systems for configured benefits and reimbursement methodologies. Experienced candidates must demonstrate working ...

Dane Street, LLC

Disability Claims QA

$22 - $30/hr

As a Disability Claims QA - Long Term Disability Specialist, you will leverage your expertise in long-term disability claims to review and ensure to accuracy and completeness of reports accompanying ...

Centivo

Supervisor Claims QA

Buffalo, NY · Remote

$70K - $78K/yr

The Supervisor Claims QA is primarily responsible for overseeing the daily operation of the Claims Quality Team, including handling all aspects of the Claims' Quality Review program, implementing and ...

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Qa Claims information

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$15

$29

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How much do qa claims jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for qa claims in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What is a QA Claims job?

A QA Claims job involves reviewing and analyzing insurance claims to ensure accuracy, compliance, and adherence to company policies and industry regulations. Professionals in this role identify errors, inconsistencies, or potential fraud while providing feedback for process improvements. They work closely with claims adjusters and management to enhance efficiency and maintain quality standards. Strong attention to detail, analytical skills, and knowledge of insurance guidelines are essential for success in this role.

What are the typical daily tasks and challenges faced in a QA Claims position?

A QA Claims role involves reviewing claims files for accuracy, completeness, and compliance with company policies and regulations, often requiring careful analysis and documentation. You may be tasked with identifying trends, proposing process improvements, and providing feedback or training to claims adjusters to enhance quality standards. One common challenge is balancing the high volume of claims with the need for thorough quality checks, especially during peak periods. These professionals often collaborate closely with claims teams, auditors, and compliance staff to resolve complex cases and streamline workflows, making attention to detail and strong communication essential for success.

What are the key skills and qualifications needed to thrive in the Qa Claims position, and why are they important?

To thrive as a QA Claims professional, you need a strong understanding of insurance claims processes, quality assurance methodologies, and attention to detail, often supported by industry certifications such as CPCU or AIC. Familiarity with claims management systems, data analysis tools, and workflow tracking software is typically required. Excellent analytical thinking, effective communication, and problem-solving skills help you excel in identifying discrepancies and collaborating with adjusters or other departments. These abilities are vital for ensuring claim accuracy, regulatory compliance, and continuous process improvement within an insurance organization.

More about Qa Claims jobs
What cities are hiring for Qa Claims jobs? Cities with the most Qa Claims job openings:
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Qa Claims jobs near you
Infographic showing various Qa Claims job openings in the United States as of June 2026, with employment types broken down into 94% Full Time, 3% Part Time, and 3% Contract. Highlights an 89% Physical, 4% Hybrid, and 7% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.
Manual QA Claims Tester

Manual QA Claims Tester

Avani Technology Solutions, Inc.

Getzville, NY • On-site

Full-time

Posted 14 days ago

Job description

Role : Manual QA Claims Testers
Location : Getzville,NY
Duration : 6 + Months
Job Description:
  • Facets- hands-on experience in configuration and administration of Trizetto claims solution.
  • Healthcare- 5-10 years+ in healthcare claims experience, ideally facets claims systems
  • Requirements Management- 5+ years' experience in working with business or IT executives/sponsors to gather requirements, understand business needs and provide solutions.
  • Prepared Test cases and Test scripts from the requirements and Functional, Technical specifications.
  • Validated member eligibility and eligibility inquiry in the facets application to the legacy application in order to confirm the migration successful or not.
  • Experience in Medical, Pharmacy Plan changes from one plan to other plan with in Group, subgroup, class combinations.
  • Experience with COB (coordination of benefits) application with in facets, testing of claims status for selected subscribers.
  • Writing test cases and test scripts in MS Excel Manually and uploading in Quality center
  • Well experienced in benefit coding of different products for various plans of BCBS such as Blue preferred, Blue exchange etc..
  • Calculating co-pay, coinsurance, adding single tier, multi tier for different products with in a plan.
  • Comparing plan and product details in medical module, and reviewing the benefit summary and feeding them into pivot tables with appropriate co-pay and coinsurance and valid comments for various codes of vision, maternity etc..
  • Test data entry into FACETS4.7 application in the test environment for creating groups, subscribers and family members.
  • Experience in creating new groups, subgroups, subscribers as and when needed which is later used as a test data for testing purpose.
  • Experience in System testing and UAT testing of the facets core application and custom modules as needed.
  • Claims validation in Facets application which includes claims pending status, member status, etc..
  • Creating test cases, test scripts for various modules, and uploading them into quality center.

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