Duties :
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.
Skills :
Required Skills and Abilities : 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. Required Software and Other Tools : Microsoft Office. Work Environment : Typical office environment.
EEO :
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