Quality SpecialistInsurance

CHCS Services Inc
US - Florida - Pensacola
July 1, 2024

At CHCS Services, we are committed to providing innovative healthcare solutions while fostering a supportive and inclusive work environment for our employees. By investing in our employees' well-being and professional development, we can succeed together as a team. Thank you for considering CHCS Services for your employment opportunities.

* Job Summary*

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

Supervisory Responsibilities:

This job has no supervisory responsibilities.

Duties/Responsibilities:

Review all policy and claim level transactions against the standard operating procedures.
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.
In-depth insurance knowledge. Focusing on long-term care insurance and benefit eligibility determinations is a plus.
Promote an exceptional level of excellence and pride in Customer Service
Integrity/Honesty
Sound interpersonal and communication skills
Motivation
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.
Organizational/Planning/Organizing
Proficiency in basic computer applications is required. (MS Word, MS Excel)
Need the ability to read and comprehend simple instructions, short correspondence, and memos. Candidate should have the ability to write simple correspondence with minimal errors. Ability to effectively present information in one- on-one and small group situations to customers, clients, and other employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

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
Motivation
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.
Organizational/Planning/Organizing
Proficiency in basic computer applications is required. (MS Word, MS Excel)
Need the ability to read and comprehend simple instructions, short correspondence, and memos. Candidate should have the ability to write simple correspondence with minimal errors. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Physical Requirements:

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made for individuals with disabilities to perform the essential functions. *While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision.

*Education -Experience

High school diploma or equivalent required
Experience in a related area preferred.
Basic computer experience
Experience with Microsoft, excel, word, teams, and document scanning.

Language Skills

Must have the ability to read and interpret documents such as policies and operating and procedural manuals; Ability to speak effectively to other employees of the organization.

Competencies Critical Thinking; Work Standards; Decision-Making; Communication; Interpersonal Skills; Integrity/Honesty and Adaptability/Flexibility

Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form; Ability to deal with problems involving several concrete variables in standardized situations.

Standard Company Requirements:

Collaborative team spirit.
Accountable and able to work independently.
Able to pass background screening and drug tests pre and post-hire - includes THC
Verification of high school, GED, or college diploma upon request.
Timely responses from three professional references.
Able to provide ongoing access to a sma[MM1] [ND2] rt phone for Multi-Factor Authentication and communication purposes.

Read the full job description and apply online on the recuiter's web-site

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