Cobalt Benefits Group, LLC (DBA: Blue Benefit Administrators, CBA Blue & EBPA)

QA Engineer

• Perform audits on production, company guidelines, and system configurations to maintain quality standards.
• Conduct internal Prepay and Post-pay audits to identify discrepancies and ensure compliance.
• Execute LDLA (Licensee Desk-Level Audit) processes.
• Perform MTM (Member Touchpoint Measures) audits and prepare monthly reports.
• Work closely with external auditors to support their review processes and ensure audit readiness.
• Respond promptly and professionally to email correspondence from internal and external stakeholders.
• Identify and address quality issues, proposing solutions to enhance claims processing workflows.
• Actively participate in the development and enforcement of quality assurance procedures and guidelines.

Medical Claims Quality Assurance Analyst

Customer Support

• Handle high-volume inbound calls with professionalism, empathy, and accuracy.
• Provide clear, accurate information regarding health insurance benefits, claims, billing, and eligibility.
• Assist members in navigating online resources and submitting requests.
• Document all call interactions in customer management systems in compliance with company and regulatory requirements.
• Adhere to call handling standards, including average handle time, quality scores, and first call resolution targets.
• Follow compliance guidelines including HIPAA, CMS, and state-specific regulations.
• Escalate complex issues appropriately to ensure timely resolution.
• Stay current with updates to health plan policies, systems, and processes.
• Contribute to continuous improvement by identifying trends and opportunities for enhanced customer experience.

Health Benefits Customer Service Representative

Full-stack Engineer

• Translate business requirements into software solutions adhering to the architecture and technical standards of the strategic business unit
• Develop, maintain and refactor in-house data extract/transformation console applications and web-based workflow management utilities
• Foster a collaborative team environment, contributing to software development standards, code reviews, and version control
• Act as a technical resource for server-based third-party applications within team scope, ensuring smooth operations and troubleshooting as needed
• Monitor and address daily performance events, ensuring optimal functionality
• Protect operations by keeping information confidential
• Coordinate or assist in the creation of policies and procedures by the software architecture/technical standards working group, with primary focus on architecture
• Assist in developing the company software product roadmap
• Support and develop software engineers by providing advice, coaching, code reviews and educational opportunities

Medical Claims Quality Assurance Analyst

Health Benefits Customer Service Representative

Software Developer – Healthcare Insurance TPA