Smart Data Solutions is a healthcare technology company helping health plans, healthcare payers, and third-party administrators (TPAs) automate complex operational workflows across claims, prior authorization, and healthcare document processing.

For more than 26 years, we have partnered with healthcare organizations to modernize operations through AI-driven workflow automation, document intelligence, and interoperability solutions. Today, we support 500+ healthcare organizations nationwide while processing billions of healthcare transactions each year.

Our approach eliminates the fragmentation, rework, and operational friction created by disconnected point solutions.

At the core of Smart Data Solutions is a unified AI-native automation platform designed for healthcare operations.

The platform connects intake, document intelligence, and workflow automation to structure, validate, and orchestrate data before it reaches downstream systems. This ensures accuracy, interoperability, and auditability across regulated healthcare environments.

Senior Quality Assurance Analyst

Smart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Senior Quality Assurance Analyst to join our team!

The Senior Quality Assurance Analyst is a high‑level quality resource responsible for leading advanced quality investigations, audits, and continuous improvement activities across healthcare operational workflows, including claims processing, mail intake, data capture, and clearinghouse functions. The Analyst ensures accuracy, compliance, and operational integrity by identifying defects, analyzing trends, determining root causes, and driving corrective and preventive actions that enhance overall performance.

What you’ll be doing?

Conduct advanced quality audits of claims, EOBs, mail intake, data capture, and clearinghouse outputs to verify accuracy, correct benefit application, contract compliance, and processing integrity.

Identify, document, and track defects or discrepancies found during audits or quality reviews and ensure issues are resolved through appropriate corrective and preventive actions.

Investigate complex or escalated issues to understand end-to-end workflows, determine root causes, and recommend actions that prevent recurrence.

Monitor and triage quality issues submitted through internal systems such as Salesforce and ensure timely research, documentation, and resolution.

Analyze audit outcomes, trends, and quality performance metrics to identify risks, recurring issues, and systemic gaps that require improvement.

Develop clear and actionable quality reports, dashboards, and summaries that communicate quality health, risks, and improvement progress to leadership and stakeholders.

Partner with Operations to embed quality controls into daily workflows, reduce rework, and improve first-pass accuracy.

Collaborate with Product, Engineering, Implementation, Automation, and Compliance teams to ensure quality requirements are incorporated into system design, configuration, enhancements, and change initiatives.

Support internal and external audit readiness by maintaining clear documentation, audit trails, and evidence that meet client, regulatory, and SOC-related expectations.

Support client implementations and operational changes by defining quality requirements, acceptance criteria, and validation steps.

Serve as a liaison between Quality Assurance and cross-functional partners to ensure alignment, transparency, and consistent execution of quality standards.

Provide mentorship, guidance, and calibration support to junior QA staff and operational teams and contribute to training materials, SOPs, and job aids.

Maintain quality documentation, policies, procedures, and artifacts to support operational readiness and compliance.

Promote a culture of quality, continuous improvement, and accountability throughout the organization.

Perform other duties as assigned to support the Quality Assurance program.

Required skills:

At least 7 years of experience in healthcare payer operations and quality-focused roles.

Extensive hands-on experience in claims processing and payment, coordination of benefits, appeals, and benefit interpretation.

Strong working knowledge of Medicare and Medicaid program requirements and related regulatory expectations.

Experience performing quality assurance reviews, operational audits, defect identification, and root cause analysis within payer environments.

Ability to analyze complex datasets, interpret trends, and convert findings into actionable recommendations.

Solid understanding of EDI transactions such as 837, 835, and related healthcare data standards.

Demonstrated ability to write clear documentation, maintain thorough audit evidence, and ensure alignment with internal and external compliance expectations.

Strong problem-solving skills with the ability to investigate issues end to end and recommend effective corrective actions.

Excellent verbal and written communication skills with the ability to collaborate across operational, technical, compliance, and client-facing teams.

High attention to detail and the ability to manage multiple priorities in a fast-paced environment.

Proficiency with Microsoft 365 tools, including SharePoint for data repository and workflow management, Power BI for reporting and visualization, Power Automate for process automation, and Excel for data analysis.

Preferred: Experience with payer systems, benefit configuration, provider contracts, or claims system testing.

Preferred: Familiarity with SOC audit requirements, NCQA principles, or other quality and compliance frameworks.

Preferred: Experience supporting system changes, user acceptance testing, or operational readiness assessments.