Claims QA Specialist

Website: IDEA VENTURE STUDIO

Location: Remote

Status: Full-time

Position Summary

PawPay is seeking a detail-oriented team member 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