Senior Insurance Quality Assurance Specialist

Seeking an experienced and analytical Senior Insurance Operations Quality Assurance Specialist, this full-time remote position will conduct comprehensive quality audits across operational areas, focusing on Supplemental Health claims, while partnering with operational leaders to enhance quality and processes. Key Responsibilities Conduct daily quality audits for assigned departments, ensuring accuracy, completeness, and compliance with policies and regulations Perform comprehensive audits of complex Supplemental Health claims, applying in-depth claims-processing knowledge to assess accuracy and support of claim decisions Identify processing errors and trends, providing feedback to leadership and recommending corrective actions for operational improvement Required Qualifications High School Diploma or GED 3+ years of health claims experience Strong understanding of claims processing workflows and Supplemental Health claim administration Ability to interpret policy provisions, benefit requirements, limitations, and exclusions Exceptional analytical and critical-thinking skills