Quality Assurance Specialist 2, PCU

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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Wellcove

WebsiteLinkedInAll 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.

📋 Description

• Review policy administration and claim-level transactions against standard operating procedures • Maintain review of daily and monthly billing suspense items • Review benefit eligibility determinations for compliance with policy contractual obligations • Assign and document mechanical and financial errors • Maintain working knowledge of long-term care products and services • Maintain departmental production and quality standards • Support policy review decisions in the appeal process • Report monthly quality results to engagement managers and supervisory staff • Participate in client-level meetings • Create client-agreed action plans and meet timelines and deliverables • Comply with HIPAA, confidentiality, and private health information regulations • Perform other assigned duties

🎯 Requirements

• In-depth insurance knowledge; long-term care insurance and benefit eligibility determination knowledge is a plus • Exceptional customer service orientation • Integrity and honesty • Sound interpersonal and communication skills • Motivation • Ability to multitask • 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 and planning skills • Proficiency in basic computer applications, including MS Word and MS Excel • Ability and flexibility to work overtime as required • Compliance with HIPAA, confidentiality, and private health information regulations

🏖️ Benefits

• Ability and flexibility to work overtime as required