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    Quality Review and Audit Lead Analyst - St Louis, United States - Hire Talent

    Hire Talent
    Hire Talent St Louis, United States

    3 weeks ago

    Default job background
    Description

    Service Reliability:
    Quality Review and Audit Lead Analyst - PBM (High Band 3)


    POSITION SUMMARY


    The Quality Review and Audit Lead Analyst is responsible for facilitating the analysis, research, and risk assessment of claims/system processing issues.

    The lead analyst will use an in depth understanding of technical principles, theories, and concepts in the field of quality to perform a thorough root cause and corrective action analysis.

    In addition to supporting tickets for root cause analysis, the lead analyst will be engaged in strategic initiatives to drive continuous improvement in the process to support our enterprise business.

    Required Qualifications

    3-5 years experience in Root Cause and Corrective/Preventive Action

    Excellent verbal and written business communication skills

    Knowledge including Microsoft Office; Outlook, Word, Excel, PowerPoint and SharePoint

    Knowledge of Client platforms preferred: Service Now, RSAM, Polaris

    Adapt to a dynamic work environment, learn quickly, solve problems and make decisions with minimal oversight

    Demonstrate initiative, commitment, and ability to work under pressure and meet tight deadlines

    Demonstrated ability to work collaboratively with other departments to resolve complex issues with strategic & innovative solutions

    Preferred Qualifications

    BA/BS degree

    Healthcare acumen

    Corrective Action/Preventive Action Management

    Responsibilities

    Review, analyze, and appropriately disposition tickets for RC/CA Analysis

    Collaborate with Business Partners to ensure correct root cause is established and a solid corrective action/preventive action is in place

    Utilize system platform to manage tickets and accurately capture/categorize all necessary trend information

    Review submitted data for quality and accuracy

    Support projects and initiatives which drive department strategy

    Assist in training, documentation, and other duties required to sustain and improve process performance

    Partner with Service Operations & PBM Customer Services to execute on action plan deliverables

    Share and communicate pertinent information with internal partners
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