Your Daily Mission

Use knowledge and experience to drive process review and changes. Conduct service line audits to identify issues while ensuring compliance with service line policies, procedures, customer expectations, contract requirements and industry standards. Support implementation of operational, process or system enhancements needed to improve process efficiency or quality.

Who You Are

• High school diploma or GED required; associate or bachelor’s degree in a related field is preferred.
• 1-2 years of experience in a quality assurance or auditing role, or equivalent experience in an operational role within the relevant service line.
• Experience with speech analytics software (e.g., CallMiner)
• One year of service line knowledge to properly audit associate performance
• Solid understanding of Medicaid, Medicare, Disability, or Social Security
• Basic understanding of our service line databases (e.g., Eligibility Assist, Compass, Premium Assist)
• Proficiency in Microsoft Office Suite, with an emphasis on Excel (including pivot tables and charts), PowerPoint and Word
• Solid applied business statistics (normal distributions, estimation, confidence intervals and hypothesis testing)
• The ability to analyze data and create reports.

The Reality of the Role

Audit Execution:

• Perform regular audits of calls and accounts against established criteria to ensure compliance, accuracy, and quality.
• Utilize speech analytics tools to monitor and evaluate associate interactions.
• Document audit findings with clear, objective, and constructive feedback.
• Reporting and Data Analysis:
• Compile and analyze audit results into comprehensive monthly/quarterly reports and presentations. Deliver presentation of findings to service line leaders in regularly scheduled meetings.

• Maintain and manage audit-related data in Excel, SharePoint, and other designated systems to ensure accuracy and accessibility.
• Analyze audit data to identify trends, root causes of errors, and opportunities for process improvement.

Training and Collaboration:

• Collaborate with service line leaders and the training department to discuss audit findings and develop action plans.
• Facilitate training sessions for new hires to review audit criteria and quality expectations.
• Conduct refresher training for associates who require additional support based on audit performance.

Team and Program Engagement:

• Actively participate in team meetings, calibration sessions, and one-on-one coaching with the Quality Manager.
• Manage or contribute to quality recognition programs, such as "Quality Heroes," to promote a culture of excellence.
• Update and maintain audit documentation, including criteria and procedures, for assigned service lines.
• Other duties as assigned.