Independent Health Quality Auditor in Williamsville, New York
The Quality Auditor-Enrollment will perform auditing and quality assurance procedures on the processes associated with membership eligibility, membership data and membership materials management. They are responsible for performing quality assurance procedures and audits at a statistically significant volume through seasonal volume fluctuations, recording and reporting results and trending and escalating any pertinent issues to front line supervisors and/or managers. The Quality Auditor-Enrollment is accountable for collaborating with the Quality Assurance and Compliance Administrator as well as the Management team to accomplish production auditing and quality assurance procedures within departmental and regulatory requirements. They will support feedback and training, trend analysis, process improvement and regulatory compliance. Over time and holiday work may be required to meet service standards.
High School diploma or GED required; Associates degree preferred.
Three (3) years of auditing, quality assurance or training experience with capacity for proficiencies in outcome improvement required. Demonstrated quality and compliance accuracy scores; health care industry experience preferred.
Demonstrated ability to work accurately at a demanding pace in order to meet or exceed minimum production goals.
Highly detail oriented, while simultaneously maintaining awareness of overall production and accuracy goals.
Demonstrated ability to understand and articulate complex systems, process and/or concepts and influence outcomes through clear and effective communication and collaboration.
Ability to quickly learn and adjust to new tasks and adhere to established standards.
Demonstrated proficiency in various computer applications including but not limited to proprietary systems, internet and intranets and Microsoft Office.
Demonstrated ability to work independently under strict deadlines, maintain confidentiality and make decisions commensurate with position responsibilities.
Demonstrated ability to work collaboratively with others at all levels of an organization to achieve common goals.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
A. Quality assurance and auditing
Perform quality assurance procedures and audits accurately at a statistically significant volume through seasonal volume fluctuations. Quality assessment reviews of all aspects of enrollment entry:
o Perform audit of critical and non-critical fields on new eligibility records.
o Perform audit of associated eligibility documentation submitted with application.
o 100% review of work performed by new associates, providing feedback to front line supervisors and/or manager until such time as associate meets minimum defined quality standards.
o Focused review and retraining of associates upon request of front line supervisor and/or manager and/or quality scores consistently below defined standard.
o Retrospective reviews of work returned due to errors.
o Random review of all requests for changes to existing eligibility records.
Quality assessment and auditing of member materials production including ID cards and premium invoice generations.
B. Reporting and training
Influence customer-centric performance outcomes through clear and effective communication and collaboration with Quality Assurance and Compliance Administrator and front line production supervisors and managers:
o Develop effective relationships that support appropriate feedback and development efforts.
o Support establishment of departmental “quality benchmarks” and report on success of corresponding quality improvement efforts.
o Report Membership Operations representative quality and productivity results through Administrator and/or Supervisor. Assist as requested in providing re-training suggestions for the associates.
o Assist the department Trainer and the management team in the design and development of training, structure and tools including standard operating procedures, training handbook and other materials.
C. Process auditing and improvement
Systematically review standard operating procedures (SOP), policies, inter-departmental relationships and systems support/integrations against best practice standards, efficiency, customer outcome improvement and regulatory/auditing standards and collaboratively recommend changes.
Remain informed of current and upcoming changes in State, Federal and internal regulations. Collaborate with the management team to review updates to departmental processes and policy to remain in compliance.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here at https://www.independenthealth.com/AboutIndependentHealth/Careers/AdditionalEEO-AAPInformation for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via their Career Worklet.
Independent Health, a not-for-profit health plan headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio of progressive products include HMO, POS and EPO products, Medicare and Medicaid plans, traditional indemnity insurance, individual and small group Exchange products, consumer-directed plans and health savings accounts, plus coverage for self-funded employers.
Independent Health has augmented its highly successful insured product portfolio with services employers and employees need to better manage their health care expenses through its affiliate companies, including the Independent Health Foundation, Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, and DxID.
Our award-winning customer service, dedication to quality health care and unmatched relationships with physicians and providers has allowed us to be consistently recognized as one of the highest-ranked health insurance plans in the nation.
We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.