Health Insurance - QA - UW, Claims & Finance

As a Health Insurance Quality Assurance professional with expertise in Underwriting, Claims, and Finance, you will play a crucial role in ensuring the accuracy, compliance, and efficiency of insurance processes within our organization. Your responsibilities will include: Quality Assurance in Underwriting: - Carefully evaluate insurance applications to verify their accuracy and compliance with company policies. - Review underwriting decisions to confirm alignment with risk assessment protocols. - Collaborate with underwriters to refine risk evaluation processes and enhance overall underwriting efficiency. Claims Management: - Monitor and audit claims processing activities to ensure strict adherence to regulatory standards. - Identify discrepancies or errors in claims and work closely with the claims team to promptly resolve them. - Develop and implement quality control procedures to improve claims accuracy and operational efficiency. Financial Oversight: - Accurately record financial transactions related to claims and underwriting processes. - Conduct regular audits of financial records to identify and prevent fraudulent activities. - Collaborate with the finance team to streamline financial reporting procedures and ensure compliance with industry regulations. To excel in this role, you should possess: Qualifications: - A degree in Health Information Management, Insurance Studies, Finance, or a related field. Experience: - Proven experience in quality assurance within the insurance industry, with expertise in underwriting processes, claims management, and financial auditing. Technical Skills: - Proficiency in utilizing insurance software and data analysis tools. - Strong analytical and problem-solving skills. Soft Skills: - Exceptional attention to detail and organizational abilities. - Effective communication and teamwork skills. With 4 to 7 years of relevant experience, you are well-positioned to contribute effectively to our team and drive continuous improvement in our health insurance operations.,