Audit Quality Specialist

SUMMARY:

Perform production and quality audits to ensure operations are effective, consistent and in compliance with business rules and processes. Primary focus includes, but is not limited to, auditing the Service Center teams Claims Support, Business Development, Billing Service Center. Responsible for performing administrative and support tasks which may be highly confidential and sensitive in nature.

PRIMARY RESPONSIBILITIES:

• Conducts and executes the production statistics and quality audits of completed work in comparison to established documented procedures to determine accuracy within the Service Center in a timely fashion while being in compliance with statutory regulations (30%).
• Partner with management, union representatives, human resources, and team members to establish and maintain production and quality standards for Service Center teams (15%).
• Compile, create, prepare and review information, audits and reports for accuracy as requested or scheduled. This includes analyzing trends of data, providing feedback, creating reports and recommending best practice guidelines within the Service Center (15%).
• Analyze, evaluate and make recommendations for process improvements, may attend training sessions and management meetings to understand changes to processes, regulations and workflows for production and quality standards (20%).
• Act as a consultant and advise management on production statistics and quality measures established or suggestions for potential changes and assist with developing an action plan for improvement (15%).
• Participate in complex projects as assigned (5%)
• Works with minimal supervision.
• Maintains confidentiality at all times.
• Will audit remainder of Service Center teams.
• Train and mentor other members of the team
• Attend meetings representing the audit team as well as meetings to establish or modify production quality standards for any Service Center team

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

A. EDUCATION REQUIRED:

Associate's degree in insurance, business or a related field. The combination of relevant education and work experience may be considered in lieu of a degree.

B. EXPERIENCE REQUIRED FOR AUDIT QUALITY SPECIALIST:

Two (2) years experience with AF Group within the Claims, Business Development, Finance, Service Center or equivalent Enterprise experience that provides the necessary skills, knowledge and abilities.

OR

Three (3) or more years experience in an insurance organization which provides working knowledge in one or more of the following areas: claims management, underwriting, finance or auditing.

C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED

• Some knowledge of the Workers Compensation Act, Claims, Billing and Policy processes and procedures for multiple states.
• Some knowledge of underwriting rules, procedures and Workers Compensation classifications for multiple states.
• Analytical and problem-solving skills to identify opportunities for improvement and recommend possible solutions.
• Ability to review and analyze documents while capturing information to support final reports or data analysis.
• Ability to effectively exchange information clearly and concisely, present ideas, report facts and information, respond to questions as appropriate.
• Ability to comprehend consequences of various situations to make appropriate individuals aware of same for decision making.
• Ability to read, analyze and interpret data, policy documents, technical, medical, legal and financial information as well as processes, procedures and manuals.
• Excellent verbal and written communication skills
• Ability to manage multiple projects and meet necessary deadlines.
• Basic knowledge of computers, word processing and ability to type 40 WPM
• Intermediate knowledge of spreadsheet software.
• Ability to perform mathematical calculations.
• Ability to proofread documents for accuracy of spelling, grammar, punctuation and format/edit as necessary.
• Ability to maintain confidentiality at all times.
• Thorough knowledge of the Workers Compensation Act, Claims, Billing and Policy processes and procedures for multiple states.
• Thorough knowledge of underwriting rules, procedures and Workers Compensation classifications for multiple states.
• Ability to understand and implement audit processes and procedures for new state specific or jurisdictional changes. Knowledge of relevant guidelines and regulations for multiple states related to insurance.

D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:

• Ability to create surveys and survey criteria.
• Completion of industry recognized quality or internal audit certification(s).
• Advanced knowledge of industry best practices related to sound internal controls and audit techniques.
• Ability to assist in the development and implementation of policies, practices, and procedures.
• Insurance education coursework.
• Certification or progress toward certification in courses focused on but not limited to Quality Auditor, Quality Manager, Six Sigma or other quality designations is highly preferred and encouraged

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Minimal travel.