QC Specialist Operations
About The Position
Renaissance Benefits is hiring a QC Specialist, Operations. The role identifies, analyzes, and recommends process improvements to increase quality and efficiency. It audits claims processing, group implementations, eligibility, and data-entry functions; analyzes results for compliance with quality, production, and performance standards; and prepares, maintains, and distributes productivity and quality-control reports. The specialist works with trainers, supervisors, and management to address trends such as customer-service issues, processing problems, and data errors, including through coaching and advanced staff training. The position also supports management with inventory reports, maintains current department documentation, and helps develop and monitor action plans addressing audit deficiencies.
Requirements
- Associate degree, technical, vocational, or business school education with coursework in business administration, and three years of work experience in a claims-processing environment; the employer will accept any suitable combination of education, training, or experience.
- Knowledge of dental terminology, procedures, insurance products, and claims processing.
- Advanced knowledge of word processing and spreadsheets.
- Ability to identify process weaknesses that may affect quality.
- Ability to resolve complex problems and exercise independent judgment.
- Effective verbal and written communication skills and organizational skills.
- Ability to collaborate effectively.
- Ability to handle multiple projects and deadlines.
- Ability to recommend improvements that increase quality and efficiency.
Responsibilities
- Audit claims processing, group implementations, eligibility, and various data-entry functions.
- Compile and analyze audit data to determine compliance with quality, production, and performance standards.
- Develop, prepare, maintain, and distribute productivity and quality-control reports.
- Identify, analyze, and recommend process or operational improvements to enhance efficiency, quality, and operational effectiveness.
- Assist management staff with inventory reports.
- Partner with trainers, supervisors, and management on trends identified through quality monitoring, including customer-service issues, processing problems, and data errors requiring staff coaching or advanced training.
- Recommend, develop, and control quality-control production programs and procedures.
- Initiate and facilitate action plans to address deficiencies identified in audits, and monitor and maintain related documents.
- Recognize and communicate employee development needs and assist with training programs.
- Verify that department documentation is current and supports quality guidelines.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
