Senior Claim Benefit Specialist

Job Description: • Conduct standard quality reviews and audits to ensure compliance with internal policies, procedures, and regulatory guidelines • Identify, document, and communicate errors to business partners for resolution • Support daily operations and maintenance of assigned functional units • Analyze audit data to identify trends and recommend process improvements • Participate in special projects and targeted quality audit initiatives • Provide subject matter expertise on workflows, systems, and operational procedures • Collaborate with business owners to support the design and implementation of new processes • Develop and implement quality programs and contribute to test plan development • Analyze and resolve complex claims scenarios within established timeframes • Respond to internal and external customer inquiries and complaints • Monitor and reconcile system activity to ensure data integrity and financial accuracy Requirements: • 1–2+ years of experience in a quality audit or claims testing environment • Working knowledge of PPO networks and healthcare claims processing • Strong analytical and problem-solving skills • Proficiency in using systems and tools for data analysis and auditing Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings • Tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access • Many other benefits depending on eligibility Apply tot his job Apply To this Job