Medical Claims Quality Assurance Analyst

About the Company

• Cobalt Benefits Group (CBG) is a trusted third-party administrator specializing in self-funded benefit plans.
• CBG helps employers find high-quality coverage at an affordable cost.
• We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue.
• With over 30 years of experience and a team of more than 200 employees, we build customized self-funded health plans, manage claim payments and disputes, and administer programs like FSAs, HSAs, COBRA, and retiree billing.

Responsibilities

• Quality Standards and Auditing:
  • Perform audits on production, company guidelines, and system configurations to maintain quality standards.
  • Conduct internal Prepay and Post-pay audits to find discrepancies and make sure things comply with rules.
  • Execute LDLA (Licensee Desk-Level Audit) processes.
  • Perform MTM (Member Touchpoint Measures) audits and prepare monthly reports.
• Collaboration and External Engagement:
  • Work closely with external auditors to support their review processes and get ready for audits.
  • Respond quickly and professionally to email correspondence from internal and external people.
• Process Improvement and Problem-Solving:
  • Identify and address quality issues, suggesting ways to make claims processing workflows better.
  • Actively take part in creating and enforcing quality assurance procedures and guidelines.

Requirements

• Associate’s degree or 2 or more years of relevant experience in quality assurance, auditing, or claims processing.
• Minimum 2 years of internal claims processing experience, preferably in a healthcare benefit or TPA setting.
• Strong working knowledge of Microsoft Office Suite (Outlook, Word, Excel).
• Proven expertise in claims processing and a deep understanding of related systems and workflows.
• Demonstrated customer service skills with the ability to manage both internal and external relationships well.
• Exceptional problem-solving and analytical skills to evaluate data and find patterns.
• Ability to work independently, set priorities, and meet deadlines in a high-pressure setting.
• Strong organizational skills with the capacity to plan and manage multiple assignments at the same time.

Preferred Qualifications (Nice to Have)

• Familiarity with auditing tools or software.
• Knowledge of healthcare regulations and compliance rules, including HIPAA.
• Experience with TPA operations and plan administration processes.

Benefits

• After successfully completing a waiting period, eligible Full-time employees have access to our benefits package, including:
  • Medical, dental, and vision insurance (60 day waiting period).
  • Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible.
  • Company provided Basic Life and AD&D.
  • Company paid Short-Term and Long-Term Disability (90 day waiting period).
  • Flexible Spending Accounts (60 day waiting period).
  • 401(k) Retirement Plan with up to a 6% employer-match (100% fully vested after 3 years).
  • 10 or more paid holidays.
  • Generous paid vacation and sick time.
  • Annual Volunteer Paid Day.
  • Annual Tuition Reimbursement.
  • Annual Health and Wellness Reimbursement.

Salary

• $47,000 to $51,000/year

Category

Healthcare