Educational Qualification: Graduate (B-Pharma)
Role Summary:
The Quality Analyst (QA) for Prior Authorization ensures accuracy, compliance, and quality of
all PA requests processed by the team. The role focuses on auditing cases, identifying defects,
and driving performance improvements.
Key Responsibilities:
- Audit prior authorization cases for accuracy, completeness, and adherence to payer guidelines.
- Review clinical documentation and decision rationale for compliance.
- Identify quality gaps and provide clear, constructive feedback to associates.
- Maintain QA logs, scorecards, and trend reports.
- Participate in calibration sessions to ensure scoring consistency.
- Recommend process improvements to reduce errors and improve turnaround time.
- Support training needs based on audit insights.
Required Skills:
- Strong understanding of prior authorization workflows and payer policies.
- Good knowledge of medical terminology and documentation review.
- High attention to detail and analytical skills.
- Effective communication and feedback delivery.
Experience:
- Prior QA or prior authorization experience preferred.
Pay: Up to ₹600,000.00 per year
Work Location: In person
