Duration: 3+ Months (possible Contract to Hire) Job Description:- Under direct supervision, performs quality control audits, reviews, and monitoring of departmental operations functions, including claims, membership, customer service/call center, workflow, processing support systems, procedures, and documentation.
- Identifies problems, analyzes cause and effect, and makes recommendations for improvement.
- Onsite interviews will be conducted.
- Training is 2-3 weeks.
- Schedule: Monday–Friday, 8:00 AM–4:30 PM (7:30–4:00 or 8:30–5:00 can be accommodated)
Responsibilities:
- Perform routine quality audits, reviews, and monitoring across operations functions to ensure quality standards, procedures, and methodologies are followed (50%).
- Recognize and document potential fraud and abuse situations.
- Provide one-on-one guidance to new hires after completion of initial training, as needed.
- Provide feedback and coaching to operations and training areas on errors found so additional training can be initiated (20%).
- Compile data and generate reports on quality performance for operations areas.
- Identify areas of weakness and recommend changes and improvements to training materials (20%).
- Document findings of analysis and prepare recommendations for new systems, procedures, or organizational changes.
- Assist with training documentation and development of new processes and procedures; stay current with all guidelines and work instructions (10%).
Experience:- 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.
- Preferred: 1 year of experience in the healthcare or insurance industry.
Skillsets: - Microsoft Office.
- Good analytical, customer service, and organization skills.
- Basic business math proficiency.
- Able to document problems and assist in their resolution.
- Able to document processes and identify areas for improvement.
- Effective written and verbal communication skills.
- Detail oriented, organized, and able to complete tasks as assigned.
Education:
- High School Diploma or equivalent.
Additional Qualifications: - Work environment: typical office environment.
About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit
www.ustechsolutions.com.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
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