ZipRecruiter

Log In

1

Senior Claims Quality Analyst Jobs (NOW HIRING)

NYC Health Hospitals

Claims Quality Analyst

New York, NY · On-site

$55K - $65K/yr

Position Overview The Claims Quality Analyst is responsible for reviewing claims to determine if ... Other duties as assigned by senior management Minimum Qualifications * Associate degree required;

Corvel

Claims Quality Assurance

Dallas, TX · On-site

$70K - $116K/yr

... analysis, investigation, valuation, reserving, compliance and accurate disposition of claims. This ... Lead QA projects and serve as primary coordinator for senior leadership of assigned offices

Primma, LLC

Senior Claims Analyst

Trenton, NJ · On-site

$85K - $98K/yr

A Senior Claims Analyst will investigate, evaluate, and resolve claims while ensuring compliance with regulatory and company policies. Essential Duties & Responsibilities: * Follow standard claims ...

Primma, LLC

Senior Claims Analyst

Roslyn, NY · On-site

$85K - $98K/yr

A Senior Claims Analyst will investigate, evaluate, and resolve claims while ensuring compliance with regulatory and company policies. Essential Duties & Responsibilities: * Follow standard claims ...

Corvel

Claims Quality Assurance

Dallas, TX · Remote

... analysis, investigation, valuation, reserving, compliance and accurate disposition of claims. This ... Lead QA projects and serve as primary coordinator for senior leadership of assigned offices

Primma, LLC

Senior Claims Analyst

Trenton, NJ · On-site

$85K - $98K/yr

A Senior Claims Analyst will investigate, evaluate, and resolve claims while ensuring compliance with regulatory and company policies. Essential Duties & Responsibilities: * Follow standard claims ...

next page

Showing results 1-20

All JobsClaims Quality Analyst JobsSenior Claims Quality Analyst Jobs

Senior Claims Quality Analyst information

See salary details

$22

$48

$92

How much do senior claims quality analyst jobs pay per hour?

As of Aug 5, 2026, the average hourly pay for senior claims quality analyst in the United States is $48.92, according to ZipRecruiter salary data. Most workers in this role earn between $35.82 and $53.37 per hour, depending on experience, location, and employer.

What are some typical challenges faced by senior claims quality analysts and how can they be addressed?

Senior Claims Quality Analysts often encounter challenges such as identifying process inefficiencies, ensuring compliance with regulatory standards, and balancing the need for thorough analysis with timely claim processing. Effective communication and collaboration with claims adjusters and other stakeholders are vital to address discrepancies and implement process improvements. Staying updated on industry regulations and leveraging quality assurance tools can also help manage these challenges and maintain high standards.

What is the difference between Senior Claims Quality Analyst vs Claims Quality Analyst?

AspectSenior Claims Quality AnalystClaims Quality Analyst
Required CredentialsBachelor's degree, certifications like CPCU or ASQBachelor's degree often preferred, certifications optional
Work EnvironmentInsurance companies, third-party administratorsInsurance companies, claims departments
Employer & Industry UsageCommonly used in larger organizations for quality oversightEntry to mid-level roles in claims processing

The Senior Claims Quality Analyst typically has more experience, advanced certifications, and responsibilities overseeing quality assurance processes. The Claims Quality Analyst focuses on processing claims accurately and ensuring quality at an operational level. Both roles are essential in insurance claims departments but differ mainly in seniority and scope of responsibilities.

What are the key skills and qualifications needed to thrive as a senior claims quality analyst?

To thrive as a Senior Claims Quality Analyst, you need expertise in claims processing, quality assurance methodologies, and a thorough understanding of insurance regulations, typically supported by a bachelor's degree and experience in claims management. Familiarity with claims management systems, auditing tools, and data analysis software such as Excel or SAS is commonly required. Attention to detail, analytical thinking, and strong communication skills help professionals identify errors and drive process improvements. These skills ensure the accuracy, compliance, and efficiency of claims operations, safeguarding both the organization and its clients.

What is a senior claims quality analyst?

Senior Claims Quality Analysts are experienced professionals who evaluate and ensure the accuracy, consistency, and compliance of insurance claims processing. They review claims files, audit claim decisions, and identify trends or errors to improve the overall quality of claims handling. In addition, they may develop training materials, work with claims teams to implement best practices, and report findings to management to help enhance operational efficiency and customer satisfaction.
More about Senior Claims Quality Analyst jobs
What cities are hiring for Senior Claims Quality Analyst jobs? Cities with the most Senior Claims Quality Analyst job openings:
What are the most commonly searched types of Claims Quality Analyst jobs? The most popular types of Claims Quality Analyst jobs are:
What states have the most Senior Claims Quality Analyst jobs? States with the most job openings for Senior Claims Quality Analyst jobs include:
What job categories do people searching Senior Claims Quality Analyst jobs look for? The top searched job categories for Senior Claims Quality Analyst jobs are:
Senior Claims Quality Analyst jobs near you
Infographic showing various Senior Claims Quality Analyst job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $101,756 per year, or $48.9 per hour.

Claims Quality Analyst

NYC Health Hospitals

New York, NY • On-site

$55K - $65K/yr

Full-time

Medical, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

NYC Health + Hospitals rating

7.5

Company rating: 7.5 out of 10

Based on 74 frontline employees who took The Breakroom Quiz

233rd of 887 rated healthcare providers

Job description

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.
Position Overview
The Claims Quality Analyst is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State and Plan's established guidelines and/or policies and procedures. The incumbent will research, review, and suggest process improvements, training opportunities and is a resource of information to all staff. The incumbent will also perform special projects.
Work Shifts
9:00 A.M - 5:00 P.M
Duties & Responsibilities
  • Audit daily processed claims through random selection based on set criteria.
  • Document, track, and trend findings per organizational guidelines
  • Based upon trends, determine ongoing Claims Examiner training needs, and assist in the development of training curriculum.
  • Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions.
  • Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational
    requirements and applicable regulations
  • Assist in the development of Claims policies and procedures
  • Provide backup for other trainers within
    the department
  • Assist in training of new departmental staffs
  • Assist with the research and resolution of audit appeal
  • Asist with external/internal regulatory audits
  • Identify policies or common errors requiring retraining sessions.
  • Participate in quality projects as required.
  • Collect, analyze data, identify trends, write reports (i.e., the monthly and quarterly reports) and present findings to the appropriate claims service management personnel.
  • Other duties as assigned by senior management

Minimum Qualifications
  • Associate degree required; Bachelor's degree preferred
  • Minimum of 4 years of experience performing claims quality audits in a NYS-based managed care setting
  • Expertise in both professional and institutional claims coding, and coding rules required.
  • Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required.
  • Strong knowledge of CMS Medicare and NYS regulations required.
  • Experience in training development and presentation preferred

Professional Competencies
  • Strong organizational, analytical, and oral/written communication skills required.
  • Proficiency in PC application skills, e.g., excel, word, PowerPoint, etc.,
  • Must be able to follow direction and perform independently according to departmental
  • Integrity and Trust
  • Must have excellent interpersonal, verbal, and written communication skills

#LI-Hybrid
#MHP50
Benefits
NYC Health and Hospitals offers a competitive benefits package that includes:
  • Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
  • Retirement Savings and Pension Plans
  • Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
  • Loan Forgiveness Programs for eligible employees
  • College tuition discounts and professional development opportunities
  • College Savings Program
  • Union Benefits for eligible titles
  • Multiple employee discounts programs
  • Commuter Benefits Programs

What NYC Health + Hospitals employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply