Conduct regular audits of financial transactions related to claims funding, billing, and stop loss submissions processed by the teams to ensure adherence to industry regulations and internal policies & procedures
Review and analyze reports to identify discrepancies, errors, or trends that may impact financial performance
Support all external audit requests and audit of materials gathered prior to submission
Maintain accurate and organized records of all quality control activities, including audit results, corrective actions taken, and follow-up measures
Act as a subject matter expert for projects aimed at process improvement and operational excellence
Recommend process changes based on audit findings and industry standards to improve overall service delivery
Prepare detailed reports summarizing findings and presenting them in a clear and actionable format to management
Participate in cross-functional meetings to discuss quality issues and propose solutions
Accountable for reaching target metrics related to quality & performance improvements
Assist in the development of departmental policies and procedures
Provide training and support to staff on quality control processes and compliance requirements
Assist with researching and resolution of client issues
Assess the need for a sense of urgency with all work activities and communicate appropriately with department leadership to coordinate response/resolution.

Associate’s degree or equivalent work experience
Previous experience in quality control, auditing, or compliance within the finance or healthcare insurance sector
Strong analytical skills and high attention to detail and accuracy
Strong organizational skills with the ability to manage multiple priorities
Work within specified timeframe and meet deadlines.
Strong customer service orientation and ability to build relationships.
Excellent knowledge of MS Office & proficient in data analysis tools and software (e.g. Excel, SQL)
Effective verbal and written communication skills; experienced in collaborating with internal teams, vendors, and customers to resolve inquiries.

Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the duties and responsibilities of the position.

Quality Control Analyst

Key skills