Claims Audit Specialist_Quality Assurance

Job Description

REQUIREMENTS

• Preferred Bachelor’s degree in related field or equivalent combination of experience and education
• One (1) year of related experience: Quality Review, Quality Assurance, or Process Improvement preferred
• Three (3) years of related experience in Claims required
• Bilingual skills a plus
• Proficiency in Microsoft Office

RESPONSIBILITES

• Responsible for conducting a quality review of functions performed
• Recommend corrections/changes to the systems, policies, and procedures, to ensure a higher quality of work performed
• Provide feedback to associates and management to improve how individuals and departments can improve workflow to eliminate repeated errors
• Assist the department Manager with conducting a routine review of the quality program to ensure it constantly meets business and regulatory requirements
• Provide regular feedback and recommendations to department Manager regarding staff performance and improvement
• Responsible for conducting quality reviews and maintaining documentation as mandated by control activity for SSAE 16 and Financial audits
• Assist in department/corporate projects, as assigned by department Manager/Director, in an effort to ensure that system upgrades, changes in policies, procedures or benefits are introduced into the department accurately and timely
• Other duties as assigned

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