This role is responsible for ensuring the delivery of high-quality services through the development, implementation, and management of quality control and audit processes. The company relies on the QA Manager to identify quality gaps, reduce errors, ensure compliance, and improve internal processes. The ideal candidate is a strong leader, analytical thinker, and skilled collaborator who can drive performance while building and leading a high-functioning QA team.
 

Key Responsibilities

• Prepare comprehensive quality documentation and reporting by collecting, analyzing, and summarizing data and trends related to: External audits, claims prepayment and post-payment audits, MTM (Member Touchpoint Measurements) audits, LDLA (Licensee Desk Level Audits), and LOS (Local Operation Scorecard) Audits.
• Serve as the liaison for MTM and LDLA with the Association on behalf of both BBA and CBA.
• Maintain and enhance product and service quality by conducting product, company, system, and compliance audits.
• Monitor and assess quality testing, identifying areas of improvement to ensure testing accuracy and reliability.
• Oversee the QA team's responsibilities in Plan Testing and RX Testing, ensuring that newly implemented plans meet quality standards to prevent future errors.
• Lead, mentor, and manage the Quality Assurance team, including Training new team members on quality procedures, defining departmental structure and roles, and ensuring adherence to internal and external quality standards.
• Collaborate cross-functionally with other departments to: Identify quality-related gaps, share insights on trending issues, and provide education and recommendations for process improvement.

• 5+ years of experience in quality assurance and claims, with at least 1 year in a leadership role.
• Strong understanding of healthcare administration, claims processing, and audit procedures.
• Proven experience with MTM and LDLA processes is highly desirable.
• Excellent analytical, organizational, and problem-solving skills.
• Effective communication skills, both written and verbal.
• Proficiency in quality management systems and audit tools.