Medical Claims Quality Assurance Analyst

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1 hour ago

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

💵 $47k - $51k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

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

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Who We Are:

51 - 200 employees

📋 Description

• 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.

🏖️ Benefits

• Fantastic medical, dental, and vision insurance* • Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible! • Company provided Basic Life and AD&D • Company paid Short-Term and Long-Term Disability** • Flexible Spending Accounts* • 401(k) Retirement Plan with up to a 6% employer-match** • WOW! (100% fully vested after 3 years) • 10+ paid holidays • Generous paid vacation and sick time • Annual Volunteer Paid Day • Annual Tuition Reimbursement • Annual Health and Wellness Reimbursement