Quality Assurance Specialist Jobs

About The Position

Requirements

• In-depth insurance knowledge.
• Focus on Long Term Care Insurance and Benefit Eligibility determinations a plus.
• Promote an exceptional level of excellence and pride in Customer Service.
• Integrity/Honesty.
• Sound interpersonal and communication skills.
• Motivation.
• Ability to multi-task.
• Meticulous attention to detail.
• Ability to lead others through performance and professionalism.
• Ability to work in a fast-paced environment.
• Highly developed problem-solving skills.
• Organizational/Planning/Organizing.
• Proficiency in basic computer applications is required. (MS Word, MS Excel)

Responsibilities

• Review all policy administration and claim level transactions against the standard operating procedures.
• Maintain the review of all Daily and Monthly billing suspense items.
• Responsible for reviewing benefit eligibility determinations to ensure that the claim recommendations meet the contractual obligations of the policy.
• Assign and document all mechanical and financial errors as discovered.
• Maintains a strong working knowledge base of all Long-Term care products and services.
• Maintain production and quality standards established in the department.
• Participate and support policy review decisions in the appeal process.
• Monthly reporting to all engagement managers and supervisory staff on the quality results of their department and staff.
• Participate in client level meetings.
• Create action plans as agreed upon with the client and meet all timelines and deliverables.
• Complying with company regulations regarding HIPAA, confidentiality, and private health information.
• Other duties may be assigned.
• Ability and Flexibility to work overtime as required.