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Job Requirements of Quality Control Specialist:
-
Employment Type:
Contractor
-
Location:
New Jersey, US (Onsite)
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Quality Control Specialist
Careers Integrated Resources Inc
New Jersey, US (Onsite)
Contractor
Quality Control Specialist
Hours: 8:30a - 5:30p
Duration: 6 months (Could be Temp to perm)
We are seeking a highly detail-oriented Quality Control (QC) Specialist to support the operations of the New Jersey Arbitration Program. This role is critical to ensuring that arbitration payment determinations are accurate, compliant, and aligned with regulatory standards under the New Jersey Carriers pursuant to the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act P.L. 2018, c.32.
The QC Specialist will play an essential role in maintaining the integrity of determinations by auditing outcomes and supporting consistent, fair, and compliant decision-making.
Key Responsibilities
Audit arbitration payment determinations for accuracy, quality, and regulatory compliance
Ensure determinations align with applicable New Jersey statutes, ONET requirements, and program guidelines
Identify errors, inconsistencies, or compliance risks and recommend corrective actions
Support continuous quality improvement through documentation of findings and trends
Work within a production-based environment to meet performance metrics and deadlines
Required Skills & Qualifications:
Minimum of three (3) years of experience in arbitration, mediation, or equivalent dispute resolution, including experience with healthcare benefits, coverage, and/or payment matters
Experience is strongly preferred in the capacity of an attorney, paralegal, nurse, or other healthcare management professional
Trained to conduct arbitrations; certification to conduct arbitrations is strongly preferred
Commitment to ongoing continuing education related to the arbitration field throughout the term of the contract
Must be familiar with healthcare Explanation of Benefits (EOBs) and able to accurately interpret payment and adjustment information
Core Competencies
Exceptional Attention to Detail: Ability to ensure precision and accuracy to maintain compliance with federal and state regulations and support defensible determinations
Hours: 8:30a - 5:30p
Duration: 6 months (Could be Temp to perm)
We are seeking a highly detail-oriented Quality Control (QC) Specialist to support the operations of the New Jersey Arbitration Program. This role is critical to ensuring that arbitration payment determinations are accurate, compliant, and aligned with regulatory standards under the New Jersey Carriers pursuant to the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act P.L. 2018, c.32.
The QC Specialist will play an essential role in maintaining the integrity of determinations by auditing outcomes and supporting consistent, fair, and compliant decision-making.
Key Responsibilities
Audit arbitration payment determinations for accuracy, quality, and regulatory compliance
Ensure determinations align with applicable New Jersey statutes, ONET requirements, and program guidelines
Identify errors, inconsistencies, or compliance risks and recommend corrective actions
Support continuous quality improvement through documentation of findings and trends
Work within a production-based environment to meet performance metrics and deadlines
Required Skills & Qualifications:
Minimum of three (3) years of experience in arbitration, mediation, or equivalent dispute resolution, including experience with healthcare benefits, coverage, and/or payment matters
Experience is strongly preferred in the capacity of an attorney, paralegal, nurse, or other healthcare management professional
Trained to conduct arbitrations; certification to conduct arbitrations is strongly preferred
Commitment to ongoing continuing education related to the arbitration field throughout the term of the contract
Must be familiar with healthcare Explanation of Benefits (EOBs) and able to accurately interpret payment and adjustment information
Core Competencies
Exceptional Attention to Detail: Ability to ensure precision and accuracy to maintain compliance with federal and state regulations and support defensible determinations
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