Operations – Quality Assurance Specialist III
Purpose
The Quality Assurance Specialist III is an advanced-level auditor position performing in-depth system and procedural audits. This role conducts regular reviews and audits of internal controls within each functional area for strengths and weaknesses, ensuring special focus to the specific risk areas. The incumbent is considered a Subject Matter Expert (SME) in their audit field and provides a comprehensive analysis of transaction, systems, and procedures.
Essential Functions
50% Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents, and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution
20% Assists in development of special department projects and participates in department and divisional projects
10% Participates in the creation and implementation of new methods, processes, and/or products
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Preferred Qualifications
Knowledge of quality assurance and production technologies.
Expert. Proficient in Microsoft Office programs.
Extensive knowledge of industry standards, quality control techniques, and procedures.
Advanced. Excellent communication skills both written and verbal.
Excellent analytical and problem-solving skills.
Strong interpersonal skills.
Excellent research and organizational skills.
Licenses/Certifications
ECA Certified Quality Assurance Manager.
Coding certification (CPC or COC, CPMA et.).
Claims and insurance experience.
Medical records auditing.
Education Level
High School Diploma or GED
Experience
5 years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience.
2 years’ experience as Quality Assurance Specialist II.