Quality Review and Audit Analyst, Individual Dental Operations

This is a fully remote position, open to applicants in Texas.

📋 Description

• Perform quality assessments through call monitoring, transaction evaluations, claim reviews, or analysis of operational systems and records.

• Assess work in relation to established procedures, audit guidelines, quality benchmarks, business necessities, and regulatory requirements.

• Consistently apply scoring criteria and quality controls.

• Conduct routine and moderately complex audits while adhering to productivity, accuracy, and timeliness standards.

• Document audit findings and maintain relevant supporting records.

• Recognize and record errors, procedural shortcomings, recurring observations, and potential trends.

• Escalate any unusual circumstances, compliance issues, customer-impacting matters, and technical obstacles.

• Enter, validate, organize, and summarize audit data utilizing designated systems, trackers, reporting tools, Microsoft Excel, and other approved resources.

• Aid in the preparation of standard audit reports, summaries, report distribution, questionnaires, case validation, error responses, and evidence collection.

• Engage in calibration sessions, training, coaching, job shadowing, and knowledge-sharing activities.

• Stay updated on procedures, audit guidance, products, systems, and business requirements.

• Identify gaps in processes, procedures, audit guidance, and documentation.

• Contribute to quality and process-improvement initiatives, testing, and validation efforts.

• Foster relationships with Quality Assurance colleagues and matrix partners.

• Assist with onboarding through job shadowing or process demonstrations when required.

⛳️ Requirements

• Relevant experience in healthcare operations, customer service, benefits, eligibility, claims, contact center operations, quality assurance, auditing, or a similar business context.

• Ability to adhere to detailed audit procedures, scoring guidelines, and quality standards.

• Exceptional attention to detail and dedication to accurate documentation and data entry.

• Capability to identify errors and convey findings clearly and professionally.

• Basic analytical and problem-solving abilities.

• Competence in managing assigned tasks and meeting set deadlines.

• Strong written and verbal communication skills.

• Ability to work effectively within a team and matrixed business setting.

• Proficiency in Microsoft Office applications.

• Capacity to learn and utilize systems necessary for executing assigned audit tasks.

• Flexibility to adapt to changing procedures, workloads, and business demands.

• Prior experience conducting audits, quality reviews, call monitoring, transaction reviews, or claim assessments.

• Experience in Individual Dental, Individual and Family Plans, or other healthcare or insurance operations.

• Familiarity with regulated operational environments and compliance requirements.

• Experience in entering, validating, or summarizing audit and quality data.

• Experience using Microsoft Excel or similar tools to organize data and identify basic trends.

• Understanding of customer service, benefits, eligibility, claims, or contact center operations.

• Willingness to travel occasionally based on business requirements.

🏝️ Benefits

• Option for remote work, contingent upon the necessity of a cable broadband or fiber optic internet connection with a minimum of 10Mbps download/5Mbps upload.

• Tobacco-free workplace policy.

• Support for reasonable accommodations during the online application process.