Quality Review and Audit Lead Analyst, Individual Dental Operations

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Conduct and coordinate quality assessments and audits of internal operations and vendor-supported processes.

• Assist in audit planning, case selection, evidence gathering, documentation, analysis, and reporting.

• Assess complex audit findings and collaborate with business owners or subject matter experts when necessary.

• Ensure accurate audit documentation that supports findings, conclusions, and recommended actions.

• Track audit activities and deliverables in alignment with regulatory turnaround requirements and internal standards.

• Gather and organize evidence for enterprise, regulatory, internal, or external audits.

• Identify compliance issues and escalate significant findings or risks.

• Facilitate coordination among audit professionals, operational teams, and vendor partners.

• Collect, validate, analyze, and summarize audit and quality data.

• Create and maintain reports, dashboards, and analyses regarding quality performance, findings, trends, and improvement opportunities.

• Recognize patterns, recurring findings, emerging risks, and gaps in reporting.

• Communicate analytical insights to Quality Assurance, Operations, vendors, and business partners.

• Specify data-collection requirements and address reporting deficiencies.

• Develop tracking and reporting capabilities that support changes in operating models and business growth.

• Analyze root causes, business and customer impacts, and compliance risks related to audit findings.

• Assist in corrective and preventive actions, remediation tracking, and reporting of unresolved risks.

• Present audit results and analyses to internal stakeholders and vendor partners.

• Support regulatory updates through revisions to audit tracking, workflows, job aids, procedures, and policies.

• Identify opportunities for process improvement utilizing audit results and operational observations.

• Lead or assist in enhancing audit procedures, reporting, workflows, quality controls, and customer-facing processes.

• Collaborate with Operations, Compliance, vendors, and business teams to formulate sustainable solutions.

• Evaluate if implemented changes effectively address findings and enhance quality.

• Suggest updates to controls, documentation, training, reporting, and monitoring.

• Develop, maintain, and revise audit procedures, SOPs, job aids, workflows, and documentation.

• Provide technical direction and quality-related guidance to audit professionals and team members.

• Act as a resource for audit methodology, data interpretation, documentation, and complex findings.

• Independently manage multiple assignments and priorities.

⛳️ Requirements

• A minimum of three years of relevant experience in healthcare operations, benefits, eligibility, claims, customer service, contact center operations, sales, quality assurance, or auditing.

• Proven experience in conducting quality reviews, audits, operational analyses, or similar control activities.

• Strong analytical, conceptual thinking, and problem-solving abilities.

• Capable of collecting, validating, analyzing, and interpreting quality or operational data.

• Ability to recognize patterns, assess complex findings, and propose practical recommendations.

• Exceptional attention to detail and ability to maintain accurate, supportable audit documentation.

• Skilled in managing multiple responsibilities and delivering time-sensitive work in a fast-paced environment.

• Strong written and verbal communication skills, including the ability to present findings to business and vendor partners.

• Ability to work independently, exercise sound judgment, and adjust priorities as per business needs.

• Strong collaborative skills and the ability to work effectively within a matrixed organization.

• Proficient in Microsoft Office applications, especially Microsoft Excel.

• Ability to provide technical guidance and support to colleagues without formal supervisory authority.

• Preferred: three or more years of relevant experience in a healthcare or insurance environment.

• Preferred: experience with Individual Dental, Individual and Family Plans, or other regulated health-benefits operations.

• Preferred: knowledge of applicable federal and state regulatory requirements impacting individual insurance operations.

• Preferred: understanding of the Affordable Care Act and federal exchange requirements where applicable.

• Preferred: experience with internal, external, regulatory, or vendor quality audits.

• Preferred: experience in developing quality reporting, data-collection processes, audit analytics, or performance-tracking tools.

• Preferred: experience in supporting corrective actions, process improvements, or quality-improvement initiatives.

• Preferred: experience with OnBase, Microsoft Access, Minitab, or similar data and reporting tools.

• For remote work, a cable broadband or fiber optic internet service with a minimum of 10Mbps download and 5Mbps upload is required.

🏝️ Benefits

• Remote work arrangement.

• Occasional travel based on business needs.

• Equal employment opportunity protections.

• Reasonable accommodation support for the online application process.

• Tobacco-free policy.

• Consideration of qualified applicants with criminal histories in accordance with applicable laws.