Analyst, Quality Assurance

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.

Responsibilities

• 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.
• Provides 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.
• 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.
• 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.
• Proficiency in Microsoft Office.

Nice-to-haves

• 1 year of experience in a healthcare or insurance industry.