Job Title: Quality Review and Audit Analyst Location: Remote Duration: 6 Months Work Schedule: Mon-Fri 8:00 AM - 5:00 PM
Job Description: The Quality Review and Audit Lead Analyst is responsible for facilitating the analysis, research, and risk assessment of claims/system processing issues. The lead analyst will use an in depth understanding of technical principles, theories, and concepts in the field of quality to perform a thorough root cause and corrective action analysis. In addition to supporting tickets for root cause analysis, the lead analyst will be engaged in strategic initiatives to drive continuous improvement in the process to support our enterprise business.
Required Qualifications
3-5 years’ experience in Root Cause and Corrective/Preventive Action
Excellent verbal and written business communication skills
Knowledge including Microsoft Office; Outlook, Word, Excel, PowerPoint and SharePoint
Knowledge of ESI platforms preferred: Service Now, RSAM, Polaris
Adapt to a dynamic work environment, learn quickly, solve problems and make decisions with minimal oversight
Demonstrate initiative, commitment, and ability to work under pressure and meet tight deadlines
Demonstrated ability to work collaboratively with other departments to resolve complex issues with strategic & innovative solution
Preferred Qualifications
BA/BS degree
Healthcare acumen
Corrective Action/Preventive Action Management
Responsibilities
Review, analyze, and appropriately disposition tickets for RC/CA Analysis
Collaborate with Business Partners to ensure correct root cause is established and a solid corrective action/preventive action is in place
Utilize system platform to manage tickets and accurately capture/categorize all necessary trend information
Review submitted data for quality and accuracy
Support projects and initiatives which drive department strategy
Assist in training, documentation, and other duties required to sustain and improve process performance
Partner with Service Operations & PBM Customer Services to execute on action plan deliverables
Share and communicate pertinent information with internal partners
Below is the brief introduction of SPECTRAFORCE, the benefits we offer and the disclaimers:
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation. At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $30.48/hr.
