PURPOSE:
The Specialist, Quality Assurance I is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and company guidelines. Fairly and consistently reviews team interactions with both internal and external parties to ensure accuracy and support success in executing superior service and quality.
ESSENTIAL FUNCTIONS:
Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution.
Performs in the role of coach and mentor to less tenured associates and acts as a subject matter expert on the Operations.
Assist with cross-training and skill development activities with less experienced staff in conjunction with the management team.
Proactively identifies trends and training opportunities based on quality evaluations.
QUALIFICATIONS:
Education Level: High School Diploma or GED.
Experience: 2 years progressive claims/customer service/enrollment &/or billing auditing experience, preferably in the healthcare or insurance sector.
Knowledge, Skills and Abilities (KSAs)
Basic knowledge of quality assurance and production technologies.
Proficient in Microsoft Office programs.
Basic knowledge of industry standards, quality control techniques, and procedures.
Excellent communication skills, both written and verbal.
Excellent Research and organizational skills.
Excellent decision making and interpersonal skills.
Salary Range: $41,472 - $76,032
Apply Below
Quality Assurance Specialist I (Remote)
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