Claims Quality Assurance Partner

Evolving Solution Services; Buffalo (NY); On-site; USD 29,000 - 41,000; Full time

Job summary

Evolving Solution Services in Buffalo, NY is seeking a Quality Assurance Partner to audit processed claims and support program audits. This full-time, non-exempt role requires strong attention to detail and the ability to maintain quality alongside production targets.

You will learn claim processes, conduct daily audits, help develop auditing mechanisms, review claims for accuracy, and provide feedback to improve performance. Associates degree or higher is a plus.

Qualifications

• High School Diploma or GED required.
• Minimum of five (5) years experience as a claims examiner or auditor with self-funded health care plans and processing in a TPA environment.
• Strong written and verbal communication skills.
• Analytical, organizational, and interpersonal skills with the ability to communicate with team members effectively.
• Proficiency in PC, Excel and Windows.
• Ability to collect data and draw valid conclusions.
• Ability to prioritize tasks and maintain accuracy.
• Confidentiality and discretion in handling information.
• Motivation to learn and improve processes; team-player attitude.

Responsibilities

• Learn and understand claim processes and workflows.
• Conduct daily audits of processed claims and assist with program audits.
• Develop and implement auditing and monitoring mechanisms.
• Review processed claims for accuracy.
• Provide feedback to improve quality and identify training needs.
• Assist with ancillary department tasks, including processing claims.
• Complete special projects as assigned.
• Investigate and research issues as required.
• Act as a subject matter expert and prepare performance statistics.

Skills

Auditing

Analytical thinking

Communication

Data analysis

Attention to detail

Excel

Team player

Confidentiality

Education

High School Diploma or GED

Associates Degree

Tools

Windows OS

MS Office

Data entry systems

Job description

Evolving Solution Services in Buffalo, NY is seeking a Quality Assurance Partner to audit processed claims and support program audits. This full-time, non-exempt role requires strong attention to detail and the ability to maintain quality alongside production targets.

You will learn claim processes, conduct daily audits, help develop auditing mechanisms, review claims for accuracy, and provide feedback to improve performance. Associates degree or higher is a plus.