Quality Assurance Specialist

Quality Assurance Specialist - Incentives Team

Hours : 37.5 / week, 7 : 45AM to 4PM M-F

POSITION SUMMARY

This position supports Claim Processors, Correspondents, Account Specialists and Supervisors. This position is responsible for ensuring that all claim processing, payments, billing and IT tickets meet established standards of quality including reliability, usability and performance.

ESSENTIAL RESPONSIBILITIES

• Quality check / post processed claims
• Review weekly batch files for accuracy
• Assure ongoing compliance with quality and requirements
• Evaluate adequacy of quality assurance standards
• Devise sampling procedures and directions for recording and reporting quality data
• Collect and compile statistical quantity and quality of work performed
• Process claims at the identified rate per hour
• Analyze data to identify areas for improvement
• Develop, recommend and monitor corrective and preventive measures
• Prepare reports to communicate outcomes of quality activities
• Identify training needs and organize training interventions to meet quality standards
• Draft quality assurance policies and procedures as needed

Handle tasks as assigned on a daily and weekly basis.

Provide continual feedback about the effectiveness of processes and procedures to the

Supervisor. Provide suggestions to improve area operations, efficiency, and service.

• Review claims as necessary to ensure quality and accuracy of processing (check claims processed by other team members and provide feedback to team members regarding quality of work as appropriate).
• Proof claim documents and batches prior to release.
• Conduct new employee training as assigned.
• Perform other related duties, as required and assigned
• This position makes and / or assists other team members in making decisions regarding claim and customer service issues.

The Quality Assurance Specialists performance directly impacts the financial success of the company through completing required job tasks.

These tasks ensure that processing of claims, payments, and billing is accurate and efficient. The ability to effectively work with staff is essential to the company’s success.

Technical Knowledge :

• Basic PC knowledge, including Microsoft Office products; Outlook, Word, and Excel.
• General mathematical, spelling, and grammar skills as demonstrated by successful completion of pre-employment tests.
• Basic understanding of accounting principles.

Work Experience :

Strong organizational and time management skills are needed to manage multiple tasks / priorities

SUCCESS FACTORS

• Attention to detail
• Time management skills
• Communication skills verbal and written
• Data Collection, management and analysis
• Problem analysis and problem solving
• Follow-up and organizational skills
• Flexibility and perseverance
• Self-motivation
• Patience
• Positive attitude
• Judgment
• Teamwork
• Ability to organize office procedures and prioritize workload to meet deadlines

ESSENTIAL MENTAL ABILILTIES

• Ability to process complex verbal and written instructions in English and translate them into a series of logical problem solving steps.
• Ability to work under stress.
• Ability to perform mathematical functions, including the ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to comprehend the interrelationship of various computer functions.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of instructions in written or verbal form in English.
• Ability to operate a ten-key calculator.
• Ability to operate a computer keyboard and related peripheral computer equipment.
• Ability to remain calm when adversity is encountered.
• Ability to interact with all staff.
• Ability to answer questions in a professional manner.
1 day ago