Quality Assurance (QA) Analyst – Health Insurance Claims (HITL)

Overview

Location: Hyderabad / Remote
Employment Type: Full-time / Contract
Experience: 1–3 years in health insurance claims or TPA workflows

About HealthPay

HealthPay is a fast-growing AI-first healthtech company transforming health insurance claim processing through intelligent automation. We work with leading TPAs like FHPL to digitize and accelerate the adjudication of insurance claims, ensuring faster, error-free decisions.

Role Summary

We are hiring QA Analysts to support the Human-in-the-Loop (HITL) review process for AI-processed health insurance claims. You will be responsible for reviewing and validating the outputs generated by HealthPay’s AI agents before final delivery to our TPA partners. Accuracy, attention to detail, and understanding of non-medical and medical claim components are key.

Key Responsibilities

• Review AI-generated outputs (claim decisions, deductions, itemized validations) against input hospital documents (PDFs).
• Verify accuracy of:
• Non-medical deductions
• Tariff matchings
• Medical justifications
• Policy compliance
• Flag errors or inconsistencies in AI interpretation.
• Provide corrections and feedback to the internal ML/engineering teams.
• Maintain detailed logs for each reviewed claim, ensuring traceability.
• Ensure adherence to SLA timelines and quality thresholds.
• Participate in weekly QA audits and performance reviews.

Requirements

• 1–3 years experience in:

Health insurance claim processing

TPA adjudication workflows

• Hospital billing/medical records (preferred)
• Familiarity with itemized bills, discharge summaries, policy documents, and TPA rules.
• Comfortable reviewing structured outputs and supporting documents (PDF, Excel).
• Basic understanding of exclusions, non-payables, and admissibility criteria.
• High attention to detail and ability to spot contextual errors.
• Excellent communication and documentation skills.
• Bachelor’s degree in Life Sciences, Pharmacy, Nursing, Healthcare Administration, or similar (preferred but not mandatory).

Job Type: Full-time

Pay: ₹350,000.00 - ₹600,000.00 per year

Benefits:

• Health insurance
• Provident Fund

Schedule:

• Monday to Friday
• Weekend availability

Supplemental Pay:

• Performance bonus

Application Question(s):

• How many years have you worked in health insurance claim processing or TPA adjudication workflows?
• Can you explain what non-medical deductions and non-payables are in the context of health insurance?
• What steps do you take to ensure the accuracy and completeness of your work?
• How do you document your claim review process and communicate feedback to technical or operations teams?
• Describe a situation where you had to meet strict turnaround times (SLAs) while ensuring high quality.

Work Location: In person