Quality Assurance Specialist 2, PCU

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

📋 Description

• Conduct thorough reviews of all policy administration and claims transactions to ensure compliance with standard operating procedures.

• Oversee the examination of all Daily and Monthly billing suspense items.

• Accountable for assessing benefit eligibility determinations to verify that claim recommendations align with the contractual obligations of the policy.

• Identify and document all mechanical and financial discrepancies as they arise.

• Maintain an extensive knowledge base of all Long-Term care products and services.

• Uphold production and quality benchmarks set within the department.

• Engage in and support policy review decisions during the appeals process.

• Provide monthly reports to all engagement managers and supervisory personnel regarding the quality outcomes of their department and staff.

• Participate in client meetings. Develop action plans in accordance with client agreements and adhere to all timelines and deliverables.

• Ensure compliance with company policies related to HIPAA, confidentiality, and private health information.

• Additional duties may be assigned as needed.

• Demonstrate the ability and flexibility to work overtime when required.

⛳️ Requirements

• Comprehensive knowledge of insurance, particularly in Long Term Care Insurance and Benefit Eligibility determinations is advantageous.

• Foster an exceptional standard of excellence and pride in Customer Service.

• Uphold integrity and honesty.

• Exhibit strong interpersonal and communication abilities.

• Display motivation and drive.

• Capability to manage multiple tasks simultaneously.

• Possess meticulous attention to detail.

• Ability to lead others through exemplary performance and professionalism.

• Adaptable to thrive in a fast-paced environment.

• Highly developed problem-solving abilities.

• Strong organizational, planning, and organizing skills.

• Proficiency in basic computer applications is essential (MS Word, MS Excel).

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Opportunities for professional development and career advancement.

• Comprehensive health and wellness benefits.

• Flexible work schedule options.

• Supportive and collaborative team environment.