Quality Assurance Specialist

Cobalt Benefits Group, LLC (DBA: Blue Benefit Administrators, CBA Blue & EBPA)

. Perform daily pre-pay and post-pay audits of medical claims .

Posted 9/18/2026full-timeRemote • New Hampshire • United StatesMid-LevelSenior💰 $45,000 - $51,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims auditing, benefit administration, and provider contract review, with strong analytical and problem-solving skills. Proficient in collaborating across teams to enhance quality assurance and operational processes.

Highest-signal resume keywords

Medical Claims AuditingBenefit AdministrationProvider Contract ReviewAnalytical SkillsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingQuality AssuranceBenefit Application ValidationProvider Network TieringReimbursement AccuracyOperational Quality AuditsAudit ReportingProcess ImprovementE-Verify ComplianceAdjudication

Soft Skills

Organizational SkillsProblem-Solving SkillsWritten CommunicationVerbal CommunicationIndependence

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft OutlookMicrosoft TeamsJavelina

Industry Keywords

Health InsuranceSelf-Funded Health PlansHealthcare TPABlue Cross Blue Shield StandardsLicensee Desk Level AuditMember Touchpoint Measurement

About the role

Key responsibilities & impact

Perform daily pre-pay and post-pay audits of medical claims
Validate benefit application, including deductibles, copays, coinsurance, eligibility, and plan provisions
Audit provider network tiering and reimbursement accuracy
Verify claims are processed according to provider contracts, fee schedules, and client plan designs
Identify, document, and communicate claim processing errors and trends
Conduct production, system configuration, and operational quality audits
Complete LDLA (Licensee Desk Level Audit) and MTM (Member Touchpoint Measurement) reviews
Support external client, regulatory, and internal audit activities
Participate in new client, renewal, and plan change testing efforts
Produce audit reports and recommend corrective actions and process improvements
Collaborate with Claims, Provider Maintenance, Customer Service, Configuration, and Implementation teams to resolve quality issues

Requirements

What you’ll need

Associate degree or equivalent combination of education and experience
3+ years of health insurance claims processing, auditing, or quality assurance experience
Strong understanding of medical claims adjudication and benefit administration
Experience reviewing provider contracts, pricing methodologies, and network structures
Advanced analytical, organizational, and problem-solving skills
Proficiency with Microsoft Office, including Excel, Word, Outlook, and Teams
Excellent written and verbal communication skills
Ability to work independently while managing multiple priorities
Preferred: Experience with self-funded health plans and healthcare TPA environments
Preferred: Knowledge of Blue Cross Blue Shield processes and standards
Preferred: Experience with Javelina or similar claims administration systems
Preferred: Understanding of provider network tiering and implementation testing
Must satisfy employment eligibility verification through E-Verify

Benefits

Comp & perks

Website LinkedIn All Job Openings 51 - 200 employees 💼 Consulting ⚖️ Legal 🛡️ Insurance Consulting
Legal
Insurance Cobalt Benefits Group, LLC (DBA: Blue Benefit Administrators, CBA Blue & EBPA) is a full service Third Party Administrator (TPA) that specializes in the customization, marketing, and operation of self-funded employee benefit plans. With over 30 years of experience and a team of over 195 employees, CBG provides a wide array of products and services including self-funded medical and dental plans, Flexible Spending Accounts, Health Reimbursement Arrangements, and COBRA management. CBG aims to assist employers in building custom benefit plans while managing costs and ensuring compliance with regulations.