Medical Claims Quality Assurance Analyst
Cobalt Benefits Group, LLC (DBA: Blue Benefit Administrators, CBA Blue & EBPA)
full-time
Posted on:
Location Type: Remote
Location: Remote • Florida, Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $47,000 - $51,000 per year
Job Level
JuniorMid-Level
About the role
- 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.
Requirements
- Associate’s degree or 2+ years of relevant experience in quality assurance, auditing, or claims processing.
- Minimum 2 years of internal claims processing experience, preferably in a healthcare benefit or TPA environment.
- Strong working knowledge of Microsoft Office Suite (Outlook, Word, Excel).
- Proven expertise in claims processing and an in-depth understanding of related systems and workflows.
- Demonstrated customer service skills with the ability to manage both internal and external relationships effectively.
- Exceptional problem-solving and analytical skills to evaluate data and identify patterns.
- Ability to work independently, prioritize tasks, and meet deadlines in a high-pressure environment.
- Strong organizational skills with the capacity to plan and manage multiple assignments concurrently.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
auditingquality assuranceclaims processingLDLAMTMdata evaluationproblem-solvinganalytical skills
Soft skills
customer servicecommunicationorganizational skillsindependenceprioritizationdeadline management
Certifications
Associate’s degree