Senior Quality Consultant

Position Summary/Mission:
This position is accountable for the review and handling of claim data. It uses analytical and statistical techniques and tools to evaluate and influences enhancements to business processes and improves quality data.
Fundamental Components/Job Description:
Use analytical and statistical techniques and tools to review/evaluate claim adjudication and business processes. (50%)
Influence changes/enhancements to business processes and policies to improve the member experience. (15%)
Clearly and effectively expresses ideas both verbally and in writing that contributes to business success. (10%)
Integrates data from multiple sources into a logic framework that supports decision-making and provides root cause analysis. (10%)
Interaction with various levels of the organization to effectively influence others and achieve optimal results. (5%)
Create communication strategies and presentations for both internal and external customers to educate and address continuous quality improvement initiatives. (5%)
Implements and validates improvements to work processes. (5%)
Travel: 0-10%
Background/Experience desired:
2+ years of work experience in the audit environment that reflects a proven track record/proficiency at reviewing claim data.
Rx Claim experience a plus
Excellent communication skills; Verbal and Written
Ability to prioritize work load to meet the business needs
Analytical skillset: Ability to identify trends in data and conduct the root cause analysis which supports decision making
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
1+ years work experience in the development and maintenance of policies and procedures.
2+ years work experience in the audit environment that reflects a proven track record or proficiency in the competencies noted.
General Business/Applying Reasoned Judgment/FOUNDATION
Leadership/Collaborating for Results/ FOUNDATION
General Business/Communicating for Impact/FOUNDATION
Service/Providing Solutions to Constituent Needs/FOUNDATION
Leadership/Driving Change/ FOUNDATION
Technical - Desktop Tools/Microsoft Excel/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Employment Type Regular Career Band Description Business Support & Technical

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