Quality Review and Audit Lead Analyst
Service Reliability : Quality Review and Audit Lead Analyst - PBM (High Band )
POSITION SUMMARY
The Quality Review and Audit Lead Analyst is responsible for facilitating the analysis, research, and risk assessment of claims / system processing issues.
The lead analyst will use an in depth understanding of technical principles, theories, and concepts in the field of quality to perform a thorough root cause and corrective action analysis.
In addition to supporting tickets for root cause analysis, the lead analyst will be engaged in strategic initiatives to drive continuous improvement in the process to support our enterprise business.
Required Qualifications
years’ experience in Root Cause and Corrective / Preventive Action
Excellent verbal and written business communication skills
Knowledge including Microsoft Office; Outlook, Word, Excel, PowerPoint and SharePoint
Knowledge of Client platforms preferred : Service Now, RSAM, Polaris
Adapt to a dynamic work environment, learn quickly, solve problems and make decisions with minimal oversight
Demonstrate initiative, commitment, and ability to work under pressure and meet tight deadlines
Demonstrated ability to work collaboratively with other departments to resolve complex issues with strategic & innovative solutions
Preferred Qualifications
BA / BS degree
Healthcare acumen
Corrective Action / Preventive Action Management
Responsibilities
Review, analyze, and appropriately disposition tickets for RC / CA Analysis
Collaborate with Business Partners to ensure correct root cause is established and a solid corrective action / preventive action is in place
Utilize system platform to manage tickets and accurately capture / categorize all necessary trend information
Review submitted data for quality and accuracy
Support projects and initiatives which drive department strategy
Assist in training, documentation, and other duties required to sustain and improve process performance
Partner with Service Operations & PBM Customer Services to execute on action plan deliverables
Share and communicate pertinent information with internal partners
EEO :
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