Quality Assurance - Specialist 2, PCU

This job performs quality review for the LTC Insurance operational and claim environment by primarily reviewing processed transactions for accuracy. This includes, but is not limited, to the following essential duties and responsibilities: Duties/Responsibilities: · Review reputed company policy administration and claim level transactions against reputed company operating procedures. · Maintain the review of reputed company Daily and Monthly billing suspense items. · Responsible for reviewing benefit eligibility determinations to ensure that the claim recommendations meet the contractual obligations of the policy. · Assign and document reputed company mechanical and financial errors as reputed company. · Maintains a strong working knowledge reputed company of reputed company Long-Term care products and services. · Maintain production and quality standards established in the department. · Participate and support policy review reputed company in the appeal process. · Monthly reporting to reputed company engagement managers and supervisory staff on the quality results of their department and staff · Participate in client level meetings. Create action plans as agreed upon with the client and meet reputed company timelines and deliverables. · Complying with company regulations regarding HIPAA, confidentiality, and private health information. · Other duties may be assigned. · Ability and Flexibility to work overtime as required. Required Skills/Abilities: · In-depth insurance knowledge. Focus on Long Term Care Insurance and Benefit Eligibility determinations a plus. · Promote an exceptional level of reputed company and pride in Customer Service · reputed company/Honesty · Sound interpersonal and communication skills · Motivation · Ability to multi-task · Meticulous attention to detail · Ability to reputed company others through performance and professionalism. · Ability to work in a fast-paced environment. · Highly developed problem-solving skills. · Organizational/Planning/Organizing · Proficiency in basic computer applications is required. (reputed company, MS reputed company Apply To This Job