Senior Quality Specialist

Job Summary

Serving as a quality champion, the full-time Senior Quality Specialist will guide the business by measuring and monitoring the quality and effectiveness of claim processing and customer service, while conducting audits and consulting cross-functionally to enhance customer satisfaction and operational efficiency in a remote environment.

Key responsibilities

• Conduct regular quality audits for service operations across multiple products and platforms to ensure compliance with standards
• Consult with other departments to promote changes that enhance quality service delivery to both internal and external customers
• Support targeted quality audit projects, report results, and recommend training needs and quality controls to senior management

Required qualifications

• 2+ years of health insurance work experience and/or Healthcare Insurance Quality Review
• 2+ years of experience with diagnosis codes and medical terminology
• Moderate to advanced knowledge of Excel, including V-lookups and pivot tables
• High School Diploma or equivalent GED