Quality Assurance Specialist II

Centene Corporation•Remote-FL, FL

8h•Hybrid

About The Position

Assesses the quality of departmental interactions, systems, and relevant processes through a variety of communication channels to ensure compliance of established policies and procedures are met. Works with cross functional departments to correct and improve routine quality concerns and processes. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

Requires a High School diploma or GED.
Requires 1 – 2 years of related experience.
May require vocational or technical education in addition to prior work experience.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Nice To Haves

Experience with Medicare, grievance, and CTM is highly preferred.
Experience in auditing, analytical skills, and root cause analysis is highly preferred.
Great time management, organization skills and attention to detail is preferred.
Vocation or technical education may include additional on-the-job training or continuous learning education.

Responsibilities

Monitors, inspects, and assesses the quality of interactions, systems, and processes to achieve established quality standards
Documents and reports on the quality, performance, and remediation efforts/progress of risks for leadership review and audit purposes
Identifies improvement opportunities and provides guidance material to improve department processes
Utilizes technology to continuously monitor and report on customer interaction performance
Supports in preparing and distributing internal audit reports and findings to provide knowledge on quality improvements
Assists as needed in coordinating document and data control (e.g., version control and numbering) to ensure accuracy and completeness
Supports with random quality assurance checks to ensure compliance
Upholds quality assurance policies and procedures and provides guidance or remediation plan when required
Supports process improvement opportunities (process or technology) to continuously increase efficiency and effectiveness
Assist with servicing members and/or providers as needed
Actively participate in quality calibration sessions with quality team
Assists with training of new hires as needed
Performs other duties as assigned
Complies with all policies and standards