Quality Assurance - Specialist 2, PCU
RemoteUnited States
Job Summary
Review all policy administration and claim level transactions against standard operating procedures to ensure accuracy. Maintain review of daily and monthly billing suspense items and benefit eligibility determinations to meet contractual obligations. Assign and document mechanical and financial errors while maintaining production and quality standards. Participate in policy review decisions during appeals, client meetings, and action plan development. Provide monthly quality reporting to engagement managers and supervisory staff. Comply with HIPAA, confidentiality, and private health information regulations. Work overtime as required in this hourly position.
Required Qualifications
- In-depth insurance knowledge
- Proficiency in basic computer applications
- Ability and Flexibility to work overtime as required
- Ability to multi-task
- Meticulous attention to detail
- Highly developed problem-solving skills
- Organizational/Planning/Organizing
- Sound interpersonal and communication skills
- Motivation
- Ability to lead others through performance and professionalism
- Ability to work in a fast-paced environment
Desired Qualifications
- Focus on Long Term Care Insurance and Benefit Eligibility determinations a plus
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