Quality Assurance Specialist

Global Channel Management, Inc; Mason (OH); Hybrid; USD 50,000 - 70,000; Full time

Job summary

A leading management firm is seeking a Quality Assurance Specialist in Mason, Ohio. This role involves reviewing and resolving member complaints, maintaining accurate records, and requires a strong background in claims processing and communication skills. The position offers a hybrid work model of 2 days per week.

Qualifications

• Health claims processing background required.
• Experience in grievance and appeals handling preferred.
• Strong communication skills necessary.

Responsibilities

• Review and resolve member and provider complaints.
• Maintain accurate, complete complaint/grievance records in the electronic database.
• Coordinate complaint resolution, preparing the agenda.

Skills

Claims processing

Call center experience

Strong written communication

Strong verbal communication

Job description

About the job Quality Assurance Specialist

Quality Assurance Specialist needs claims , appeals , call center experience

Quality Assurance Specialist requires:

• Hybrid of 2 days/week
• Works grievance and appeals
• Prior work experience (G&A, claims, appeals, call center, etc.)
• Strong written and verbal communication skills, and health claims processing background

Quality Assurance Specialist duties:

• Review and resolve member and provider complaints
• Maintain accurate, complete complaint/grievance records in the electronic database.
• Coordinates Complaint , preparing the agenda