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Performs complex transaction validations and case processing within established procedures, makes approval decisions, mentors new hires, serves as subject-matter expert, and improves processes with limited supervision.

Performs transaction processing and complex validations following established procedures, acts as a subject matter expert, mentors new hires, resolves client inquiries, approves or rejects cases, and reports adverse events while complying with policies and improving processes.

Performs transaction and data processing tasks following established procedures: captures, validates, pre-adjudicates, researches, and corrects data using multiple source documents. Follows up on pending items, returns electronic forms for more information, complies with policies, and works with moderate supervision to support operational processes.

Performs quality assurance and auditing tasks using established procedures: reviews processes, samples and audits transactions, reconciles data, evaluates SLAs and workflow reports, coaches Level 1 auditors, and interacts with external auditors (SOC 1). Works with moderate supervision and maintains required certifications and training.

Performs transaction processing and data validation using established procedures. Captures, pre-adjudicates, researches, and corrects data; follows up on pending items and returns forms for additional information. Works under moderate supervision and supports operational processes.

Entry-level role that receives, sorts, images, classifies, captures, verifies, and transmits client documents and data following established procedures. Works with close supervision, uses basic systems and automated extraction verification, and performs routine operational and administrative tasks to ensure accurate data flow.

Senior QA responsible for end-to-end testing of claims processing and adjudication systems. Create test plans, data, and scripts; lead release testing; validate claims lifecycle scenarios; write SQL for data validation; test web services; manage defects and test environments; collaborate with SMEs, product owners, and engineering to ensure quality and compliance.

Performs transaction processing and data validation following established procedures: captures and verifies complex data, pre-adjudicates and corrects documents, researches issues, follows up on pending items, returns data forms for additional information, and manages own workload under moderate supervision.

Lead day-to-day eligibility determination and renewal operations; supervise Eligibility HBCs; manage staffing, schedules, and workflows; monitor productivity and compliance; provide coaching, training, and corrective actions; analyze metrics, handle escalations, and ensure quality customer interactions.

Performs transaction processing and data validation using established procedures: captures and verifies complex data, pre-adjudicates and corrects documents, researches issues, follows up on pending items, returns forms for additional information, and ensures accurate inputs for downstream processes.