Quality Assurance Specialist – Medical Claims

Job overview

The Quality Assurance Specialist – Medical Claims role is onsite in South Burlington, VT. Compensation is $45,000–$51,000 per year. Cobalt Benefits Group administers self-funded benefit plans and supports employers with health coverage and claims administration. The specialist audits medical claims and related operations to verify accurate benefit administration, provider network tiering, and contract pricing. The role identifies errors and trends, recommends corrective actions, and collaborates with operational teams to support payment accuracy and service quality.

What you'll do

• Perform daily pre-pay and post-pay medical claims audits
• validate benefit application, eligibility, and plan provisions
• audit provider network tiering and reimbursement
• verify claims against provider contracts, fee schedules, and plan designs
• document errors and trends
• conduct production, system configuration, and operational quality audits
• complete LDLA and MTM reviews
• support client, regulatory, and internal audits
• participate in client and plan testing
• produce audit reports and recommend corrective actions
• collaborate with claims and related teams to resolve quality issues.

What we're looking for

Skills & competencies

quality assurance specialist

medical claims

south burlington vt

cobalt benefits group

claims auditing

benefit administration

provider networks

payment accuracy

quality oversight

$45k–$51k annual

self-funded health plans

claims operations

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision insurance
• employer HSA contributions
• basic life and AD&D
• short- and long-term disability
• flexible spending accounts
• 401(k) match up to 6%
• paid holidays, vacation, and sick time
• volunteer day
• tuition and wellness reimbursement.

Why this role

Annual salary of $45,000–$51,000; supports healthcare vertical clients through claims auditing and quality oversight.

About the employer

Cobalt Benefits Group LLC is hiring for this role. Industry: All Other Insurance Related Activities. Sector: 52.