Cobalt Benefits Group LLC-posted about 2 hours ago
Full-time • Entry Level
Orlando, FL
101-250 employees

Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Medical Claims Quality Assurance Analyst, you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The Medical Claims Quality Assurance Analyst plays a critical role in ensuring the accuracy and compliance of claims processing in alignment with plan-specific and company guidelines. This position involves enforcing quality procedures, monitoring performance, identifying and addressing quality issues, and conducting both internal and external audits. The ideal candidate is a skilled communicator who excels in verbal, written, and electronic correspondence and thrives in a dynamic, team-oriented environment. The role also demands high levels of accuracy, problem-solving, and flexibility to adapt to changing priorities.

  • Quality Standards and Auditing: Perform audits on production, company guidelines, and system configurations to maintain quality standards.
  • Conduct internal Prepay and Post-pay audits to identify discrepancies and ensure compliance.
  • Execute LDLA (Licensee Desk-Level Audit) processes.
  • Perform MTM (Member Touchpoint Measures) audits and prepare monthly reports.
  • Collaboration and External Engagement: Work closely with external auditors to support their review processes and ensure audit readiness.
  • Respond promptly and professionally to email correspondence from internal and external stakeholders.
  • Process Improvement and Problem-Solving: Identify and address quality issues, proposing solutions to enhance claims processing workflows.
  • Actively participate in the development and enforcement of quality assurance procedures and guidelines.
  • Associate’s degree or 2+ years of relevant experience in quality assurance, auditing, or claims processing.
  • Minimum 2 years of internal claims processing experience, preferably in a healthcare benefit or TPA environment.
  • Strong working knowledge of Microsoft Office Suite (Outlook, Word, Excel).
  • Proven expertise in claims processing and an in-depth understanding of related systems and workflows.
  • Demonstrated customer service skills with the ability to manage both internal and external relationships effectively.
  • Exceptional problem-solving and analytical skills to evaluate data and identify patterns.
  • Ability to work independently, prioritize tasks, and meet deadlines in a high-pressure environment.
  • Strong organizational skills with the capacity to plan and manage multiple assignments concurrently.
  • Familiarity with auditing tools or software.
  • Knowledge of healthcare regulations and compliance requirements, including HIPAA.
  • Experience with TPA operations and plan administration processes.
  • Fantastic medical, dental, and vision insurance
  • Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
  • Company provided Basic Life and AD&D
  • Company paid Short-Term and Long-Term Disability
  • Flexible Spending Accounts
  • 401(k) Retirement Plan with up to a 6% employer-match WOW! (100% fully vested after 3 years)
  • 10+ paid holidays
  • Generous paid vacation and sick time
  • Annual Volunteer Paid Day
  • Annual Tuition Reimbursement
  • Annual Health and Wellness Reimbursement
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