Sr Quality Audit Rep
Job no: 494313
Work type: Full Time Regular
|Lead, design, and monitor activities that review and/or evaluate the quality of service provided by department staff and/or external parties, to assure competent performance and adherence to the set internal and external standards and requirements as determined by the department. This includes support and accountabilities throughout the entire end-to-end process on the most complex cases. Correct areas of non compliance of department processes, through coaching and feedback on a regular basis.
Essential Job Functions:
- Lead, design, monitor, review, and evaluate the quality of service provided by department staff to measure service quality and identify non-conformance on all cases, to include those that are most complex, while maintaining production and time service goals. On a regular basis, provide coaching and feedback to individual staff members throughout the entire chain of our operations.
- Schedules staff and utilize seasoned business knowledge to deliver adequate/required service level coverage for customers.
- Schedules reviews, handles appeals and/or elevated issues, and assist management with the execution of changes to our programs as needed.
- Validate accuracy of decisions/processes for adherence to set standards and/or applicable regulations or requirements. Work with internal and external parties for resolution and overall design.
- Develop, design, and prepare reports of quality results for use by management in evaluating performance or developing training.
- Personally take accountability to execute and perform standard and complex premium and eligibility functions that are impactful throughout entire chain of our processes.
- Maintains confidentiality in the collection, maintenance and dissemination of restricted, sensitive or other information as identified by management.
- Establishes and maintains effective working relationships with personnel at all levels of the Company to assure the successful implementation and delivery of programs.
- Utilize all facets of seasoned working knowledge to recommend billing and enrollment alternatives to support the most complex and non-standard requests to establish processes and systems.
- This position is in a fast-paced, high volume environment with set production goals.
- This position requires sitting over 66% of the time.
- This position requires Visual Acuity at 20 inches (or less) over 66% of the time.
- Seasoned knowledge of group insurance concepts and operations
- Advanced Customer Service skills and ability to work effectively with various levels of personnel
- Thorough knowledge of all the Company's product lines
- Strong verbal and written communication and the ability to articulate instructions and information to other associates and customers
- Strong analytical ability, sound judgment and math aptitude
- Thorough knowledge of applicable laws and regulations
- Ability to work well under pressure and deadlines
- Highly proficient with personal computer and software applications/data entry and ability to train others
- Seasoned experience and knowledge/skills in presentation
- Seasoned experience with Compass system and GSAP (Group Sales Application)
- Strong knowlege of eligibility rules
- Strong knowledge of Group Insurance
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST.
For all other inquiries, contact our HR Helpline at 1-800-365-1405, option 4.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer, Minorities/Female/Disabled/Veteran
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.
Advertised: Central Standard Time
Applications close: Central Daylight Time
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