This role is for one of the Weekday's clients
Min Experience: 4 years
Location: Bangalore
JobType: full-time
As a Claims Quality Analyst, you will be responsible for auditing and evaluating healthcare claims to ensure adherence to payer guidelines, internal policies, and federal regulations, including
HIPAA
. You will play a key role in identifying process gaps, analyzing error trends, and recommending corrective actions to improve overall claims quality and operational efficiency.
Key Responsibilities
Conduct
quality audits and reviews of medical claims adjudication
to ensure accuracy, completeness, and compliance with payer policies and regulatory standards.
Ensure strict adherence to
HIPAA guidelines
, data privacy requirements, and confidentiality standards across all claim review activities.
Evaluate claims for correct coding, benefit application, provider eligibility, authorization, and payment accuracy.
Identify error patterns, root causes, and process deviations, and document findings in clear, structured quality reports.
Provide actionable feedback to claims processing and adjudication teams to address quality gaps and reduce rework or financial leakage.
Support the development and maintenance of
quality metrics, scorecards, and audit frameworks
aligned with organizational goals.
Collaborate with operations, training,



and compliance teams to implement corrective and preventive actions.
Participate in calibration sessions to ensure consistency in quality evaluations and scoring methodologies.
Stay current with updates to
US healthcare regulations, payer policies, and adjudication guidelines
, and apply changes effectively in quality assessments.
Contribute to continuous improvement initiatives by recommending process enhancements and best practices.
What Makes You a Great Fit
A minimum of
4 years of experience
in
US healthcare claims processing, adjudication, or quality analysis
.
Strong working knowledge of
HIPAA regulations
, medical claims workflows, and payer-specific adjudication rules.
Proven experience in conducting claim audits, quality reviews, or compliance assessments.
Solid understanding of US healthcare concepts such as eligibility, benefits, authorizations, coding, and reimbursement methodologies.
Excellent analytical and problem-solving skills with robust attention to detail.
Ability to interpret complex guidelines and translate them into clear quality feedback and improvement actions.
Strong communication skills to collaborate effectively with operations, compliance, and training teams.
A proactive, quality-focused mindset with the ability to work independently in a fast-paced environment.

📌 Claim Quality Analyst (Bengaluru)
🏢 Weekday AI
📍 Bengaluru