Quality Assurance Specialist
Posted Updated 6
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Summary
Reviews and resolves member and provider complaints, grievances, and appeals in a health claims environment, maintaining records in an electronic database and coordinating complaint meetings. Requires prior claims, appeals, or call center experience; hybrid role with 2 days/week onsite in Mason, OH.
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
- Notifying participants,