Full-Time Lead Associate - Transactional Quality

Quality Auditor Responsibilities:

• Quality assurance process, from sample selection to audits, RCA, and feedback to associates.

• Ensuring correctness and completeness of cases and regulatory compliance.

• Reporting and tracking of accuracy SLAs and KPIs.

• Quality monitoring reviews, including process documentation and call scoring.

• Assisting in developing and implementing quality management programs.

• Performing RCA for critical errors.

• Measuring and ensuring uniform performance standards for clinical review teams.

• Conducting coaching sessions for team improvement.

• Providing quality assurance training and facilitating/participating in calibration sessions.

• Escalating serious performance issues as needed.

Experience & Skills:

• Minimum 1-2 years experience with customers, providers, or members via phone.

• Prior quality assurance or relevant work experience.

• Healthcare experience a plus.

• Strong verbal/written communication and presentation skills, handling interactions with various stakeholders professionally.

• Highly motivated, independent worker with strong time management skills.

• Strong analytical and problem-solving skills.

• Proficiency in PC-based applications (word processing, databases, spreadsheets).

• Extensive knowledge of medical terminology and anatomy.

• Subject matter expertise on all contracts maintained by the Assessment unit.

• Fluency in English and Spanish.

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