Quality Assurance Specialist 2, PCU
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Job Description
Quality assurance specialist reviewing long-term care insurance policy and claim transactions for accuracy. Reporting quality results, documenting errors, and supporting appeals and client action plans.
Responsibilities:
- Review policy administration and claim-level transactions against standard operating procedures
- Maintain review of daily and monthly billing suspense items
- Review benefit eligibility determinations for compliance with policy contractual obligations
- Assign and document mechanical and financial errors
- Maintain working knowledge of long-term care products and services
- Maintain departmental production and quality standards
- Support policy review decisions in the appeal process
- Report monthly quality results to engagement managers and supervisory staff
- Participate in client-level meetings
- Create client-agreed action plans and meet timelines and deliverables
- Comply with HIPAA, confidentiality, and private health information regulations
- Perform other assigned duties
Requirements:
- In-depth insurance knowledge; long-term care insurance and benefit eligibility determination knowledge is a plus
- Exceptional customer service orientation
- Integrity and honesty
- Sound interpersonal and communication skills
- Motivation
- Ability to multitask
- 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 and planning skills
- Proficiency in basic computer applications, including MS Word and MS Excel
- Ability and flexibility to work overtime as required
- Compliance with HIPAA, confidentiality, and private health information regulations
Benefits:
- Ability and flexibility to work overtime as required
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