Quality Specialist
Core
Acts as a quality champion measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service to impact customer satisfaction, medical cost management, and operational efficiency.
Role type
Quality Specialist (Claim Processing & Customer Service)
Builds
Quality service delivery for internal and external customers in claim processing and customer service operations
Domain
Healthcare / Insurance / Administrative Services
Deliverable
dashboards & analysis
Required skills
Quality audits, process compliance monitoring, cross-functional consultation, standard operating procedure enforcement, deviation reporting, training needs analysis
Preferred skills
Audit experience, Medicare experience, healthcare environment experience
Technologies
Microsoft Office (Excel, Outlook, OneNote, Teams, PowerPoint)
Responsibilities
Conduct standard quality reviews and audits to measure team compliance with policies and procedures; Execute routine and non-routine business support tasks; Consult cross-functionally to influence and promote process changes; Report overall audit results and make recommendations regarding quality controls and procedures to senior management
Seniority
Individual Contributor, Entry to Mid-level