Quality Assurance Examiner

About the role

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.

What You’ll Do

• 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
• Able 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
• Able 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.

Benefits Package

• 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