Quality Assurance Specialist 2, PCU

This is a fully remote position, open to applicants in Florida.

📋 Description

• Evaluate policy administration and claim-level transactions in accordance with standard operating procedures

• Oversee the review of daily and monthly billing suspense items

• Assess benefit eligibility determinations to ensure compliance with policy contractual obligations

• Identify and document both mechanical and financial errors

• Maintain a comprehensive understanding of long-term care products and services

• Uphold departmental production and quality standards

• Assist in policy review decisions throughout the appeal process

• Present monthly quality results to engagement managers and supervisory personnel

• Engage in client-level meetings

• Develop action plans agreed upon with clients and adhere to timelines and deliverables

• Ensure compliance with HIPAA, confidentiality, and private health information regulations

• Execute other assigned responsibilities

⛳️ Requirements

• Comprehensive knowledge of insurance; familiarity with long-term care insurance and benefit eligibility determination is advantageous

• Outstanding customer service orientation

• High levels of integrity and honesty

• Strong interpersonal and communication abilities

• Self-motivated

• Capability to manage multiple tasks simultaneously

• Keen attention to detail

• Capacity to lead others through performance and professionalism

• Ability to thrive in a fast-paced environment

• Advanced problem-solving abilities

• Organizational and planning expertise

• Proficient in basic computer applications, including MS Word and MS Excel

• Willingness and flexibility to work overtime as necessary

• Adherence to HIPAA, confidentiality, and private health information regulations

🏝️ Benefits

• Ability and flexibility to work overtime as required