Quality Assurance Analyst
About The Position
Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Recognizes and documents any potential fraud and abuse situations. May provide one on one guidance to new hires upon completion of initial training. Provides necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed. Compiles data and generates reports for operations areas on quality performance. Identifies areas of weakness and communicates recommendations on changes and improvements to training materials. Documents findings of analysis and prepares recommendations for implementation of new systems, procedures or organizational changes. Assists with training documentation and development of new processes and procedures. Remains current with all guidelines, work instructions, etc.
Requirements
- High School Diploma or equivalent
- One year of related claims processing, customer service, auditing, training, analysis, or operations experience
- Experience with auditing
- Good analytical, customer service, and organization skills
- Basic business math proficiency
- Able to document problems and assist in their resolution
- Able to document processes and identify areas for improvement
- Effective written and verbal communication skills
- Microsoft Office to include strong proficiency with Excel creating data tables, using formulas, etc.
Nice To Haves
- One year of experience in a healthcare or insurance industry
- Experience with audition calls and claims
Responsibilities
- Performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc.
- Identifies problems, analyzes cause and effect, and makes recommendations for improvements.
- Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
- Recognizes and documents any potential fraud and abuse situations.
- May provide one on one guidance to new hires upon completion of initial training.
- Provides necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed.
- Compiles data and generates reports for operations areas on quality performance.
- Identifies areas of weakness and communicates recommendations on changes and improvements to training materials.
- Documents findings of analysis and prepares recommendations for implementation of new systems, procedures or organizational changes.
- Assists with training documentation and development of new processes and procedures.
- Remains current with all guidelines, work instructions, etc.
Benefits
- Equal opportunities in all phases of the employment process and compliance with applicable federal, state and local laws and regulations.
- Reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
- Coverage for the difference in pay for full-time employees in the National Guard or Reserves if called to active duty.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
