QA Reviewer II

Status: Non-exempt
Division/Department: Quality Assurance Department
Reports to: QA Manager

Job Description:
The Quality Assurance Reviewer II is responsible for performance of quality control procedures and external compliance audit reviews focused on ensuring compliance with Trust Distribution Procedures.  Has knowledge of commonly used concepts, practices, and procedures of claims review. Relies on instructions and pre-established guidelines to perform the functions of the job.  Works under immediate supervision.

Knowledge and Skill Requirements:

  1. Minimum of 2 years relevant work experience with an obtained level of senior reviewer.
  2. Strong working knowledge of trust requirements with the ability to learn additional trusts quickly and accurately.
  3. Average accuracy rating of at least 98% for the preceding 3 months.
  4. A consistent above average productivity rating.
  5. Knowledge of the claims review processes, procedures, and computer system.
  6. Computer literacy: Windows, Word and Excel.
  7. Adaptability to changing policies, procedures, and systems.
  8. Attention to detail and analytical skills.
  9. Compliance orientation with the ability to follow procedures.

Primary Responsibilities:

  1. Review and evaluation of claims identified for quality control/quality assurance testing to ensure accuracy, completeness and eligibility for compensation.
  2. Performance of various quality control procedures focused on increasing Company accuracy, improving performance, and identifying process improvements.
  3. Review and evaluation of claims identified for compliance auditing to ensure accuracy, completeness and eligibility for compensation as needed.
  4. Recommend changes to documented policies in an effort to ensure consistency across departments.
  5. Other specialized tasks focused on process improvement.

Working Conditions
Normal business office conditions, including working for prolonged periods of time at a computer screen. This position requires working from the physical office.
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