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

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Quality Assurance Partner

Full Time Buffalo, NY, US

6 days ago Requisition ID: 1003

Salary Range: $21.00 To $30.00 Hourly

Job Title : Quality Assurance Partner

Status: Non Exempt

Why this role is important:

Our clients and members count on us to process claims quickly and accurately. How do we do that? By delivering excellent service with only the highest quality of work. Conducting Aither’s quality assurance audits of work performed will ensure that we continue "Being Aither."

What you’ll do:

Learn and understand claim processes and work flows.

The Quality Assurance Partner will conduct daily audits of processed claims and assist with other program audits as deemed appropriate by the department manager.

Assist in the development and implementation of auditing and monitoring mechanisms.

Review processed claims with accuracy.

Maintain consistent quality and production standards, by providing feedback from audits and identifying training needs.

Assist with other ancillary department tasks as necessary, including processing claims.

Complete special projects as assigned.

Investigate and research issues as required.

Act as a subject matter expert.

Prepare and provide statistics related to individual and department performance.

What you’ll bring:

High School Diploma or GED.

Minimum of five (5) years experience as a claims examiner or auditor with self-funded health care plans and processing in a TPA environment.

Talent for communicating clearly.

Strong analytical, organizational, and interpersonal skills, with the ability to communicate with members of the team effectively.

PC, EXCEL and Windows experience.

Ability to collect data and draw valid conclusions.

Ability to prioritize.

Strong ability to focus on a task and ensure accuracy.

Ability to maintain confidentiality.

The motivation to learn and constantly improve processes.

Mindset of a team-player - you'll be ready to jump in and help on any Aither task

You might also bring:

Associates Degree

Compensation Range: $21/hr-$30/hr

Actual starting pay within this range will be determined based on several factors, including relevant experience, healthcare or TPA industry knowledge, skills, and overall qualifications. Final compensation will also take into account internal equity and market factors.

As an Equal Opportunity / Affi