Quality Review and Audit Lead Analyst, Individual Dental Operations

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

📋 Description

• Conduct and oversee quality reviews and audits of both internal operations and processes supported by vendors.

• Assist in planning reviews, selecting cases, gathering evidence, documenting findings, analyzing data, and reporting results.

• Assess complex audit findings and consult with business owners or subject matter experts as necessary.

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

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

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

• Recognize compliance issues and escalate significant findings or risks.

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

• Collect, verify, analyze, and summarize audit and quality-related data.

• Create and maintain reports, dashboards, and analyses that reflect quality performance, findings, trends, and opportunities for improvement.

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

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

• Specify data collection requirements and develop tracking and reporting capabilities.

• Analyze findings for root causes, business impacts, customer implications, and compliance risks.

• Assist in corrective and preventive actions, track remediation efforts, and report unresolved risks.

• Present audit outcomes and supporting analyses to stakeholders and vendor partners.

• Assist with regulatory changes by updating audit tracking, workflows, job aids, procedures, and policies.

• Identify opportunities for process improvement and lead or assist with improvement project components.

• Collaborate with Operations, Compliance, vendors, and other teams to devise sustainable solutions.

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

• Recommend revisions to controls, documentation, training, reporting, and monitoring practices.

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

• Offer 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.

• Manage various assignments and priorities independently while adapting to evolving business needs.

⛳️ Requirements

• At least 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 capabilities.

• Proficient in collecting, validating, analyzing, and interpreting quality or operational data.

• Ability to recognize patterns, evaluate complex findings, and communicate actionable recommendations.

• Excellent attention to detail and capability to maintain accurate and supportable audit documentation.

• Skilled in managing multiple responsibilities and completing time-sensitive tasks in a fast-paced environment.

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

• Capable of working independently, exercising sound judgment, and adjusting priorities based on 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 support and guidance to colleagues without formal supervisory authority.

• Preferred: over three years of related experience in a healthcare or insurance setting.

• Preferred: experience supporting Individual Dental, Individual and Family Plans, or another regulated health-benefits operation.

• Preferred: knowledge of federal and state regulatory requirements relevant to individual insurance operations.

• Preferred: understanding of the Affordable Care Act and federal exchange requirements when 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 enhancement projects.

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

• Preferred: willingness to travel occasionally based on business needs.

• If working remotely, an internet connection must be via a cable broadband or fiber optic provider with download speeds of at least 10Mbps and upload speeds of at least 5Mbps.

🏝️ Benefits

• Remote work/home working allowed, contingent on having a cable broadband or fiber optic internet service with a minimum of 10Mbps download and 5Mbps upload speeds.

• Occasional travel required based on business needs.

• Equal employment opportunity protections are in place.

• Support for reasonable accommodations during the online application process.

• A tobacco-free workplace policy is enforced.