Claims & Enrollment Quality Assurance

Iconma, L.L.C. Cincinnati , OH 45201

Posted 2 months ago

Claims & Enrollment Quality Assurance

Location: Cincinnati, OH

Duration: 2-3 months

Description:

  • Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

Primary duties may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders. Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

    Tracks and trends audit results, providing feedback to management. Identifies and reports on systemic issues which create ongoing quality concerns. Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.

    Produces other ad hoc reports as requested by internal and/or external clients. Associates at this level conduct routine audits, generally related to a single function on a single systems platform for a single line of business. Requires high school diploma or equivalent (GED); 2 years' experience with the company in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector); working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; ability to acquire and perform progressively more complex skills and tasks in a production environment or any combination of education and experience, which would provide an equivalent background.

Required skill sets, experiences, or methodologies (technical or otherwise):

  • Able to maintain unbiased approach to real time monitoring. Able to sit long periods of time working on computer.

Additional Job Description Details:

  • Real time agent monitoring/auditing

Qualification Rating

General Business Skills

  • High School Diploma, GED, or Equivalent Yes
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Claims & Enrollment Quality Assurance

Iconma, L.L.C.