The Quality Assurance Analyst plays a key role in organizing and facilitating the development of strategic programs, providing thorough analysis of existing processes and their implementation. This position is responsible for researching, compiling, and presenting relevant data and feedback related to risk activities

Conducts quality assurance audits of completed prospective and concurrent reviews for inpatient, outpatient, ambulatory, and ancillary services, ensuring accurate documentation, adherence to processes, and maintenance of quality standards Designs and delivers targeted educational sessions for team members concerning policies, procedures, and benefits, as appropriate Maintains comprehensive knowledge of business operations, products, and corporate organizational structure, including functional responsibilities Performs quality audits of inbound and outbound calls, confirming that all information conveyed complies with established guidelines and standards Monitors initiatives, outcomes, and objectives to verify achievement within specified parameters Develops lines of communication to convey analytical findings to management via reports and presentations, assisting management with program implementation that addresses identified issues Supports leadership through investigative review and recommendations, focusing on innovative solutions to identify and resolve root causes of operational challenges Facilitates resolution of identified issues to support key corporate objectives, adapt to change management demands, and organize and control team activities accordingly Participates in the creation of plans, reports, papers, and other materials as required Assists with User Acceptance Testing (UAT) and implementation tasks as needed Researches and evaluates data from multiple sources to detect discrepancies and patterns Supports the identification, analysis, and evaluation of assigned problems to assess existing and potential trends and issues Maintains up-to-date knowledge of business operations, products, programs, corporate structure, and research methodologies The responsibilities and tasks described herein typically reflect the duties associated with this position, though additional essential functions may be assigned as necessary

This position description outlines the principal responsibilities and tasks typically associated with this role. Additional essential functions may also be required

Requirements:

Minimum of 2 years’ experience in US Healthcare utilization management and/or quality assurance review Experience with HealthEdge HRCM, JIRA, or Guiding Care is preferred

Skills/Knowledge/Abilities (SKA) Required:

Demonstrated analytical, planning, problem-solving, verbal, and written communication skills for conveying complex ideas Proficiency with commonly used software applications (PowerPoint, Excel, Word, etc.) Ability to work independently as well as collaboratively within a team, and to communicate effectively with employees and clients across all levels of the organization Adaptability and agility in managing changing tasks and priorities. Strong attention to detail Capable of performing technical tasks such as developing business requirement documents and user training materials Ensures accuracy, consistency, and integrity of data; collaborates with operations teams to validate reports and documentation