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Quality Improvement Research Analyst
Avalon Healthcare SolutionsCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing and customer service within the healthcare sector, with strong analytical skills and a focus on continuous improvement. Proficient in SQL queries and advanced Excel for data analysis and reporting.
Highest-signal resume keywords
Claims ProcessingSQL QueriesData AnalysisMedical Billing CertificationMicrosoft Office Suite
Tech Stack
Tools & technologiesAbout the role
Key responsibilities & impact- Act as the Quality Subject Matter Expert and support team for service delivery
- Maintain in-depth knowledge of internal processes to resolve customer inquiries
- Develop, run, and execute client queries for internal reports
- Pull and prepare monthly, quarterly, and ad hoc reports for assigned clients
- Evaluate disputed claims in the denial management process for system configuration, claims processing, and/or contractual issues
- Facilitate health plan review of claims
- Support resolution of operational inaccuracies and trends
- Collaborate with the Service Delivery team and other internal departments
- Understand departmental needs and recommend process improvements
- Support special assignments and projects requiring extensive research
- Resolve client inquiries and issues by triaging requests and conducting detailed claims research
- Pull claims data and obtain information from other departments to understand and resolve operational issues
Requirements
What you’ll need- Minimum 3+ years of relevant work experience in a healthcare field, including claims processing, claims coding, customer service, and/or account management
- Bachelor’s degree preferred; 5+ years of relevant experience accepted in lieu of a degree
- Previous experience working in a health plan or healthcare services company required
- Solutions-oriented, analytical mindset
- Strong ownership and accountability for outcomes and continuous improvement
- Strong communication and consistent follow-up to keep deliverables on track
- Expert written and oral communication skills
- High attention to detail in documentation
- Working knowledge of SQL queries
- Expert computer skills, including Microsoft Office Suite; advanced Excel required
- Experience with data analysis tools preferred
- Reporting and JIRA experience preferred
- Experience or certification in medical billing and/or medical coding a plus
- Knowledge of laboratory medical coding rules and regulations, compliance, reimbursement, and bundling issues
Benefits
Comp & perks- Eligible for remote work
- Quarterly travel to Avalon’s corporate office in Tampa, Florida
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims CodingData AnalysisReportingProcess ImprovementOperational Resolution
Soft Skills
Strong CommunicationAttention to DetailOwnership and AccountabilitySolutions-Oriented MindsetCollaboration
Tools & Technologies
Microsoft ExcelJIRAData Analysis Tools
Certifications & Qualifications
Medical Billing Certification
Industry Keywords
Healthcare ServicesHealth PlanClaims ManagementComplianceReimbursement