Collective Health

QA Engineer

• Lead comprehensive quality reviews of Member Claims Advocates' work, specifically targeting complex cases, high-dollar claims, and new hire performance to rigorously assess accuracy and decision-making.
• Manage and support responses to external audit requests, ensuring data integrity and compliance.
• Actively participate in Quality team meetings and calibration sessions, championing consistent scoring methodologies and a deep understanding of key metrics.
• Consistently maintain and strive to exceed an acceptable Claim Review Accuracy level.
• Contribute significantly to data-driven trend analysis, identifying root causes and actionable insights.
• Execute ad hoc claim reviews and perform in-depth deep-dive analyses to uncover systemic issues.
• Collaborate closely with Team Leads to develop and support training initiatives.
• Ensure strict adherence to all documented QA workflows and best practices.

Senior Quality Assurance Specialist, Member Claims