Quality Assurance Specialist 2, PCU

Wellcove

Quality Assurance Specialist performing quality reviews for LTC Insurance claims and transactions. Responsible for maintaining accurate policy administration and compliance with operational procedures.

Posted 7/29/2026full-timeRemote • Florida • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates in-depth knowledge of Long-Term Care Insurance and Benefit Eligibility determinations, ensuring compliance with contractual obligations and company regulations. Exhibits strong organizational, problem-solving, and communication skills while maintaining high standards of customer service and quality.

Highest-signal resume keywords

Long-Term Care Insurance KnowledgeBenefit Eligibility DeterminationsCustomer Service ExcellenceProblem-Solving SkillsOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Policy Administration ReviewClaim Level Transactions ReviewBilling Suspense ManagementError DocumentationQuality Standards Maintenance

Soft Skills

Interpersonal SkillsCommunication SkillsAttention to DetailMotivationFlexibility

Tools & Technologies

MS WordMS Excel

Industry Keywords

HIPAA ComplianceConfidentialityPrivate Health InformationClient MeetingsAction Plans

About the role

Key responsibilities & impact

Review all policy administration and claim level transactions against the standard operating procedures.
Maintain the review of all 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 all mechanical and financial errors as discovered.
Maintains a strong working knowledge base of all Long-Term care products and services.
Maintain production and quality standards established in the department.
Participate and support policy review decisions in the appeal process.
Monthly reporting to all 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 all 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.

Requirements

What you’ll need

In-depth insurance knowledge. Focus on Long Term Care Insurance and Benefit Eligibility determinations a plus.
Promote an exceptional level of excellence and pride in Customer Service
Integrity/Honesty
Sound interpersonal and communication skills
Motivation
Ability to multi-task
Meticulous attention to detail
Ability to lead 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. (MS Word, MS Excel

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Wellcove Website LinkedIn All Job Openings 1001 - 5000 employees Founded 1989 🛡️ Insurance 🏥 Healthcare ☁️ SaaS Insurance
Healthcare
SaaS Wellcove is a third‑party administrator (TPA) focused on the senior market and long‑term care (LTC) benefits. Its cloud‑native LTC Now platform and AssuriCare services provide automated claim administration, eligibility determination, auto‑adjudication, payment processing, digital care management, provider matching, risk evaluation/analytics, and business process outsourcing for carriers, state retirement plans, and reinsurers. The company emphasizes automation, payment integrity, and tailored administrative solutions for long‑term care and Medicare supplement administration. Quality Assurance Specialist 2, PCU Job not on LinkedIn 🔥 14 minutes ago 🐊 Florida – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔧 QA Engineer (Quality Assurance) Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Review all policy administration and claim level transactions against the standard operating procedures.
Maintain the review of all 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 all mechanical and financial errors as discovered.
Maintains a strong working knowledge base of all Long-Term care products and services.
Maintain production and quality standards established in the department.
Participate and support policy review decisions in the appeal process.
Monthly reporting to all 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 all 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. 🎯 Requirements
In-depth insurance knowledge. Focus on Long Term Care Insurance and Benefit Eligibility determinations a plus.
Promote an exceptional level of excellence and pride in Customer Service
Integrity/Honesty
Sound interpersonal and communication skills
Motivation
Ability to multi-task
Meticulous attention to detail
Ability to lead others through performance and professionalism.
Ability to work in a fast-paced environment.
Highly developed problem-solving skills.
Organizational/Planning/Organizing
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