Overview
Quality Assurance Examiner Jobs in United States at Health Plans, Inc.
Title: Quality Assurance Examiner
Company: Health Plans, Inc.
Location: United States
Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.
What We Do
HPI is unique. A respected industry leader that’s been serving customers for over 44 years, we’re known for our innovation and adaptability. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.
Our commitment extends beyond our clients to our own employees. We foster a supportive and inclusive work environment where innovation thrives. By investing in our team’s growth and well-being, we ensure they are equipped to provide exceptional service.
What You’ll Do
The Quality Assurance Examiner is responsible for internal and external audits, claims error analysis, documentation of policies and procedures that guide the actions and decisions of claims processing, auditing all outside vendor reports, voiding and reissuing payments and processing vendor recoveries.
In This Role, You’ll Also
- Conduct internal audits of high-dollar claims and adjustment transactions, including audits exceeding $50,000 to $100,000+.
- Partner with external audit vendors to address questions, provide feedback, and ensure audit accuracy.
- Process claim adjustments, refunds, recoveries, voids, reissues, and Medicare demand transactions.
- Analyze adjustment and refund activity to identify trends, determine root causes, and recommend process, training, or system improvements.
- Investigate potential operational or payment issues and provide recommendations to management.
- Collaborate with provider billing vendors to request refunds, process claim adjustments, and review audit-related correspondence.
- Monitor and track adjustment activity, maintaining accurate documentation and reporting.
- Prepare and present monthly department audit results and key findings.
- Support continuous improvement initiatives by identifying opportunities to enhance accuracy, efficiency, and compliance within claims and audit processes.
What You Bring
- Bachelor’s degree or an equivalent combination of education and work experience.
- Three to five years of claims processing experience required.
- Prior experience in the healthcare or health insurance industry required.
- Strong analytical and problem-solving skills with exceptional attention to detail.
- Ability to manage multiple priorities in a fast-paced environment while maintaining a high degree of accuracy.
- Excellent organizational and time management skills with the ability to meet deadlines.
- Effective verbal and written communication skills, with the ability to interact professionally across all levels of the organization.
- Ability to work independently while also contributing collaboratively as part of a team.
- Demonstrated ability to understand system interactions and identify the downstream impact of process changes.
- Proven ability to follow through on assignments, proactively address issues, and ensure timely resolution.
- Sound judgment and discretion in handling confidential and sensitive information.
- Commitment to continuous improvement and identifying opportunities to enhance quality, accuracy, and operational efficiency.
Why choose us?
- We’re a people-first company and value giving back to our community. Ask us about our volunteer opportunities.
- Our space is a reflection of who we are—innovative, open and collaborative.
- We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks.
- Need to reenergize? When at our Westborough headquarters, take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
Our Benefits Package
We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life, including:
- Medical, Dental and Vision and Prescription Drug Coverage
- Fitness Reimbursement Benefit
- Employee Assistance Program
- Flexible Spending Account & Health Savings Account
- 401(k) and Quarterly Bonuses
- Generous Paid-Time Off & Volunteering Opportunities
- Educational Assistance & Professional Development Opportunities
So, think you want to join the HPI team? We hope to hear from you!
You can read more about us at hpitpa.com/about-us/careers/
EEO/AA/M/F/Vet/Disability Employer
