Maryland Quality & Oversight Analyst, DentaQuest

Sun Life • Baltimore, MD

312d • $50,500 - $75,800

About The Position

The Quality Analyst for the Quality oversight team is responsible for preparing, inspecting, and complying with contractual quality program requirements. In this role you will validate and/or develop improved standards, identify training needs, including root-cause analysis, and correction actions/recommend solutions for the Quality oversight department within Compliance.

Requirements

• Solid understanding of NCQA and/or URAC requirements.
• Detail oriented and organized with the ability to prioritize tasks and meet deadlines.
• Strong analytical and problem-solving skills with the ability to conduct root cause analysis and implement corrective actions.
• Accountable for contributing to a workplace environment that fosters mutual respect, cooperation, information sharing and commitment to delivering the expected service.
• Broad knowledge of Medicaid administration.
• Knowledge of federal and state laws/regulations applicable to quality and processes.
• Ability to think creatively to resolve the more complex or non-routine issues.
• Strong written and verbal communication skills and experience.
• Ability to effectively coach, develop and motivate team members to achieve Department and SLF goals.
• Strong negotiation, decision making and problem-solving skills and experience.
• Ability to develop and maintain effective, professional business relationships across all levels of the organization and external TPA administrators and customers.
• Strong PC proficiency.
• Ability to successfully meet deadlines and achieve goals.
• Knowledge of company computer systems and products.

Responsibilities

• Conduct comprehensive quality assurance assessments and audits to identify deviations, defects and non-conformities with processes and service level metrics.
• Report deficiencies to management.
• Develop and implement quality control audit plans.
• Train employees on quality standards and procedures.
• Prepare and present quality reports to senior management.
• Track and trend root cause analysis and corrective actions to address quality issues.
• Maintain quality meeting minutes for client distribution.
• Attend and participate in client meetings.
• Track quality contractual requirements and ensure compliance of such requirements.

Benefits

• Generous vacation and sick time.
• Market-leading paid family, parental and adoption leave.
• Partially-paid sabbatical program.
• Medical plans.
• Company paid life and AD&D insurance.
• Disability programs.
• 401(k) plan with an employer-paid match.
• Employer-funded retirement account.
• Flexible work environment.
• Great Place to Work® Certified in Canada and the U.S.
• Named as a 'Top 10' employer by the Boston Globe's 'Top Places to Work' two years running.

What This Job Offers