Claims QA Specialist

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: TYPE OF WORK

Full Time

: SALARY

6 USD per hour

: HOURS PER WEEK

40

: DATE UPDATED

Aug 13, 2026

JOB OVERVIEW

Apply here: ----------
Location: Remote
Status: Full-time

Position Summary
PawPay is seeking a detail-oriented tea ---------- mber to drive operational excellence across our claims ecosystem. This hybrid role bridges active claims processing and external stakeholder coordination with high-level quality auditing.

This is an excellent opportunity for individuals looking to build experience in healthcare administration, insurance operations, customer support, or claims processing.

We are looking for someone who:
Enjoys working with processes and documentation.
Is highly organized and detail-oriented.
Takes ownership of tasks and follows through consistently.
Communicates professionally and proactively.
Can work independently while collaborating with a growing team.
Is excited to help improve the experience for pet owners and veterinary clinics.

Key Responsibilities
Claims Management
Review claim documentation submitted by pet owners and veterinary clinics.
Verify that all required claim forms, invoices, medical records, and supporting documents match and are complete.
Submit claims to insurance providers.
Maintain accurate tracking of claim statuses.
Maintain organized digital records within company systems.
Monitor claims, manage workflow queues, and ensure full compliance with SOPs and insurance regulations.

Stakeholder Communication
Act as a primary liaison with insurance carriers.
Execute and audit follow-ups across phone calls, email, and SMS messaging.
Ensure all phone interactions are professional, and written emails and SMS outreach are clear and compliant to TCPA guidelines.

Quality Assurance, Financial Reconciliation and Appeals
Conduct audits on open and closed claims to review carrier decisions,
Evaluate disputed or denied claims to determine eligibility for appeals.
Execute financial reconciliation on paid invoices against approved reimbursements.
Verify the correct direction of reimbursement.
Identify discrepancies, systemic documentation issues, or trend errors.

Qualifications
Work Experience
1+ years of insurance industry experience (e.g. claims, policy administration) or 2+ years of general experience in customer service, client communications or quality auditing.
Strong understanding of workflows and compliance requirements
Excellent English communication (both written and verbal)
Comfortable with spreadsheets, CRM tools, and AI-powered platforms.

Competency Requirements
Strong attention to detail with the ability to identify process gaps, missed opportunities, and compliance risks
Proactive problem-solving mindset with the ability to recommend practical solutions
Time management and organization skills to manage claims volumes and deadlines
Adaptability to changing processes, policies, and business requirements
Able to work independently with minimal supervision.

Device Specifications
Noise-canceling headphones
Built-in or external camera
Internet Speed: Minimum of 50mbps

SKILL REQUIREMENT

Administrative Management Insurance Claims Processing

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Claims QA Specialist

Please login or register as jobseeker to apply for this job.

TYPE OF WORK

SALARY

HOURS PER WEEK

DATE UPDATED

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