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Delta Dental of Iowa seeks outstanding candidates for Quality Assurance Analyst. This is an opportunity to ensure our transactions are timely, accurate, effective, efficient, and compliant with corporate policies and procedures, federal and state regulations and contract terms by conducting routine and ad-hoc quality assurance audits/reviews of key functions, high-risk and/or complex transactions. You will assist with oversight for compliance-related functions, when needed. You will create new or update audit/review procedures, conduct audits/reviews, report findings, assist in the development of effective actions plans and follow up on such activities through completion. The functional areas include, but are not limited to: claims, member services, new/renewal business, servicing, online services, sales, accounting and other financial transactions.
Essential Functions and Principal Accountabilities:
- Conduct routine quality assurance audits/reviews of the key functions, high-risk and/or complex transaction for compliance with the company’s internal standards, federal and state laws, and contract terms.
- Assist with oversight and administer compliance-related activities, when needed.
- Develop new audit/review procedures that test the internal controls of key risks associated with each functional area and/or transaction.
- Develop and conduct ad-hoc audits/reviews for specific accounts for compliance with contractual obligations.
- Develop and work exception reports and/or queries to monitor issues or concerns.
- Partner with functional areas to determine the root cause of issues and help develop action plans to address the issues.
- Create reporting formats and report audit/review findings in a timely and accurate manner.
- Track and follow-up on the status of all open issues to ensure action plans are implemented in the most effective and efficient manner. Document and report the status on a regular basis.
- Support third-party audits and exams by responding to inquiries and/or fulfilling request.
- Foster mutually beneficial relationships with all functional areas by continually acting as a partner and resource to the area and staff.
- Bachelor’s degree in related field or equivalent work experience.
- 2-4 years’ experience, in a related role, including but not limited to, quality assurance, internal audit, information technology business analyst or test analyst, compliance, or 5 years in benefit administration in the dental or healthcare insurance industry.
- Clear and concise writing and presentation skills.
- Excellent interpersonal, analytical, and communication skills.
- Proficient skills and experience using Microsoft Office applications such as Word, Excel, Power-Point.
- Highly motivated, innovative, self-directed thinker with the ability to work independently and as part of a team.
- Demonstrated ability to prioritize, organize, and function effectively with multiple tasks/assignments.
- Knowledge of federal and state laws and regulations applicable to the health insurance carriers and/or benefit plan administration, such as Assignment of Benefits, Coordination of Benefits, ERISA, HIPAA, Affordable Care Act, and Medicaid Managed Care, etc., preferred.
- Knowledge of and/or experience using various formal or informal audit protocols, methodologies, techniques, and tools, preferred.
- Experienced using Business Objects or similar data querying tools and Visio, preferred.
Delta Dental of Iowa is an Affirmative Action and Equal Opportunity Employer committed to providing equal employment opportunity for all persons without unlawful regard of race, color, religion, sex, sexual orientation, gender identity, age, national origin, individuals with disabilities, protected veteran status, or any other legally protected basis.
EEOC Poster Supplement