Quality Assurance - Specialist 2, PCU

Wellcove; Pensacola (FL); On-site; USD 45,000 - 65,000; Full time

Job summary

Wellcove in Pensacola, FL is seeking a Quality Review Specialist for the LTC Insurance operations and claims environment. You will review policy administration and claim level transactions for accuracy and compliance, supporting client goals and HIPAA requirements.

You will maintain production and quality standards, document errors, participate in client meetings, and provide monthly quality reporting to engagement managers and supervisors.

Qualifications

• In-depth insurance knowledge with LTC focus a plus.
• Strong customer service orientation and integrity.
• Excellent communication and interpersonal skills.
• Ability to multi-task and maintain attention to detail.
• Leads others with professionalism and performance guidance.
• Works well in a fast-paced environment and adheres to HIPAA.
• Proficient with MS Word and MS Excel.

Responsibilities

• Review policy administration and claim level transactions against SOPs.
• Maintain review of daily and monthly billing suspense items.
• Verify benefit eligibility determinations to meet policy obligations.
• Document mechanical and financial errors and assign root cause.
• Maintain knowledge of Long-Term care products and services.
• Ensure production and quality standards in the department.
• Participate in client review decisions and appeals process.
• Provide monthly quality reporting to engagement managers and supervisors.
• Attend client meetings and create action plans with timelines and deliverables.
• Comply with HIPAA and confidentiality requirements.

Skills

LTC Insurance

Customer Service

Integrity

Communication

Multi-tasking

Detail oriented

Leadership

Problem solving

Tools

MS Word

MS Excel

Job description

Wellcove-Pensacola, 4900 BAYOU BLVD, PENSACOLA, Florida, United States of America

Job Description

Posted Wednesday, June 10, 2026 at 6:00 AM

This job performs quality review for the LTC Insurance operational and claim environment by primarily reviewing processed transactions for accuracy. This includes, but is not limited, to the following essential duties and responsibilities:

Duties/Responsibilities:

• Review all policy administration and claim level transactions against the standard operating procedures.
• Maintain the review of all Daily and Monthly billing suspense items.
• Responsible for reviewing benefit eligibility determinations to ensure that the claim recommendations meet the contractual obligations of the policy.
• Assign and document all mechanical and financial errors as discovered.
• Maintains a strong working knowledge base of all Long-Term care products and services.
• Maintain production and quality standards established in the department.
• Participate and support policy review decisions in the appeal process.
• Monthly reporting to all engagement managers and supervisory staff on the quality results of their department and staff
• Participate in client level meetings. Create action plans as agreed upon with the client and meet all timelines and deliverables.
• Complying with company regulations regarding HIPAA, confidentiality, and private health information.
• Other duties may be assigned.
• Ability and Flexibility to work overtime as required.

Required Skills/Abilities:

• In-depth insurance knowledge. Focus on Long Term Care Insurance and Benefit Eligibility determinations a plus.
• Promote an exceptional level of excellence and pride in Customer Service
• Integrity/Honesty
• Sound interpersonal and communication skills
• Ability to multi-task
• Meticulous attention to detail
• Ability to lead others through performance and professionalism.
• Ability to work in a fast-paced environment.
• Highly developed problem-solving skills.
• Proficiency in basic computer applications is required. (MS Word, MS Excel

Wellcove-Pensacola, 4900 BAYOU BLVD, PENSACOLA, Florida, United States of America