Senior Insurance Quality Assurance Specialist

Job Summary

Seeking an experienced and analytical Senior Insurance Operations Quality Assurance Specialist, this full-time remote position will conduct comprehensive quality audits across operational areas, focusing on Supplemental Health claims, while partnering with operational leaders to enhance quality and processes.

Key Responsibilities

• Conduct daily quality audits for assigned departments, ensuring accuracy, completeness, and compliance with policies and regulations
• Perform comprehensive audits of complex Supplemental Health claims, applying in-depth claims-processing knowledge to assess accuracy and support of claim decisions
• Identify processing errors and trends, providing feedback to leadership and recommending corrective actions for operational improvement

Required Qualifications

• High School Diploma or GED
• 3+ years of health claims experience
• Strong understanding of claims processing workflows and Supplemental Health claim administration
• Ability to interpret policy provisions, benefit requirements, limitations, and exclusions
• Exceptional analytical and critical-thinking skills