Healthcare Claims QA Specialist — Drive Accurate Payments

Cobalt Benefits Group LLC; Exeter (NH); On-site; USD 60,000 - 90,000; Full time

Job summary

Cobalt Benefits Group is seeking a detail-oriented Quality Assurance Specialist to support our healthcare vertical clients through comprehensive claims auditing and quality oversight. This role primarily conducts daily audits of medical claims to ensure accurate benefit administration, correct provider network tiering, and appropriate contract pricing.

Responsibilities include identifying errors, conducting LDLA/MTM reviews, and supporting audits with internal teams.

Qualifications

• Associate degree or equivalent combination of education and experience.
• 3+ years of health insurance claims processing, auditing, or quality assurance experience.
• Strong understanding of medical claims adjudication and benefit administration.
• Experience reviewing provider contracts, pricing methodologies, and network structures.
• Advanced analytical, organizational, and problem-solving skills.
• Proficiency with Microsoft Office, including Excel, Word, Outlook, and Teams.
• Excellent written and verbal communication skills.
• Ability to work independently while managing multiple priorities.

Responsibilities

• Perform daily pre-pay and post-pay audits of medical claims.
• Validate benefit application, including deductibles, copays, coinsurance, eligibility, and plan provisions.
• Audit provider network tiering and reimbursement accuracy.
• Verify claims are processed according to provider contracts, fee schedules, and client plan designs.
• Identify, document, and communicate claim processing errors and trends.
• Conduct production, system configuration, and operational quality audits.
• Complete LDLA and MTM reviews.
• Support external client, regulatory, and internal audit activities.
• Participate in new client, renewal, and plan change testing efforts.
• Produce audit reports and recommend corrective actions and process improvements.
• Collaborate with Claims, Provider Maintenance, Customer Service, Configuration, and Implementation teams to resolve quality issues.

Skills

Claims auditing

Analytical skills

Communication

Independent work

Multitasking

Education

Associate degree or equivalent

Tools

Microsoft Office

Excel

Word

Outlook

Teams

Javelina (claims system)

Job description

Cobalt Benefits Group is seeking a detail-oriented Quality Assurance Specialist to support our healthcare vertical clients through comprehensive claims auditing and quality oversight. This role primarily conducts daily audits of medical claims to ensure accurate benefit administration, correct provider network tiering, and appropriate contract pricing.

Responsibilities include identifying errors, conducting LDLA/MTM reviews, and supporting audits with internal teams.