[Remote] Business Analyst – Operational Compliance & Audit for Healthcare
Note: The job is a remote job and is open to candidates in USA. Technocrats Domain Inc is seeking a Healthcare Business Analyst to support operational compliance functions within the health plan. This role focuses on conducting audits and reviews to ensure adherence to regulatory requirements and internal policies, while collaborating with various teams to enhance healthcare operations.
Responsibilities
• Perform member and provider letter reviews to ensure accuracy, required disclosures, clarity, tone, and regulatory compliance
• Conduct telephone call audits to assess customer service quality, accuracy of information provided, compliance with scripts, and adherence to health plan policies
• Complete claims audit reviews to validate correct coding, benefits application, timeliness, and compliance with claim-processing procedures
• Identify gaps, inconsistencies, and areas requiring corrective action
• Ensure all reviews align with CMS, State DOH, NCQA, HIPAA, and organizational guidelines
• Document findings, trends, and variances in a structured and actionable format
• Prepare detailed audit summaries and compliance reports for leadership review
• Maintain audit logs, tracking sheets, and follow-up documentation
• Support the development of remediation plans and monitor the completion of corrective actions
• Assist in root-cause analysis and process improvement initiatives
Skills
• Bachelor's degree in Healthcare Administration, Business, Public Health, or related field (or equivalent experience)
• 3–5 years of experience in a health plan, TPA, or healthcare operations setting
• Experience in claims processing, call quality auditing, member/provider communication review, or operational compliance
• Strong understanding of healthcare concepts: claims, benefits, authorizations, eligibility, appeals & grievances, provider networks, CMS/State rules
• Excellent analytical, documentation, and written communication skills
Company Overview
• Technocrats Domain (TCD) is a trusted IT partner that works closely with clients as an extension of their IT organization. It was founded in 2000, and is headquartered in Houston, Texas, USA, with a workforce of 201-500 employees. Its website is https://www.technocratsdomain.com/.
Apply Now
Apply Now
Responsibilities
• Perform member and provider letter reviews to ensure accuracy, required disclosures, clarity, tone, and regulatory compliance
• Conduct telephone call audits to assess customer service quality, accuracy of information provided, compliance with scripts, and adherence to health plan policies
• Complete claims audit reviews to validate correct coding, benefits application, timeliness, and compliance with claim-processing procedures
• Identify gaps, inconsistencies, and areas requiring corrective action
• Ensure all reviews align with CMS, State DOH, NCQA, HIPAA, and organizational guidelines
• Document findings, trends, and variances in a structured and actionable format
• Prepare detailed audit summaries and compliance reports for leadership review
• Maintain audit logs, tracking sheets, and follow-up documentation
• Support the development of remediation plans and monitor the completion of corrective actions
• Assist in root-cause analysis and process improvement initiatives
Skills
• Bachelor's degree in Healthcare Administration, Business, Public Health, or related field (or equivalent experience)
• 3–5 years of experience in a health plan, TPA, or healthcare operations setting
• Experience in claims processing, call quality auditing, member/provider communication review, or operational compliance
• Strong understanding of healthcare concepts: claims, benefits, authorizations, eligibility, appeals & grievances, provider networks, CMS/State rules
• Excellent analytical, documentation, and written communication skills
Company Overview
• Technocrats Domain (TCD) is a trusted IT partner that works closely with clients as an extension of their IT organization. It was founded in 2000, and is headquartered in Houston, Texas, USA, with a workforce of 201-500 employees. Its website is https://www.technocratsdomain.com/.
Apply Now
Apply Now