MPF Federal is seeking a Quality Assurance Preventative Auditor and Claims Processor, responsible for executing tasks aligned with Quality Management System (QMS) preventative and quality assurance initiatives. This role involves ensuring adherence to quality standards, conducting audits, identifying areas for improvement, and enhancing operational efficiency. The auditor plays a pivotal role in maintaining the quality and consistency of operational programs, thereby reducing costs associated with poor quality. Additionally, the role includes handling Dental and Pharmacy Claims and collaborating with Clinical Quality and Dental Quality Management.
Key Responsibilities:
- Perform duties in accordance with Quality Management Systems and industry standards, ensuring processes, equipment, and systems meet quality requirements.
- Conduct regular audits of the QMS to ensure compliance with internal and external standards. This involves reviewing procedures, processes, and quality records.
- Identify potential areas of quality failure and implement preventative measures. Analyze processes, identify risks, and develop strategies to mitigate them.
- Oversee the inspection and validation of quality-related documentation. Ensure accuracy, currency, and compliance with regulatory requirements.
- Prepare detailed reports on audit findings, quality metrics, and process improvements. Maintain comprehensive records of all quality-related activities.
- Develop and suggest corrective actions for identified non-conformities or defects. Track action items and response logs.
- Maintain an audit schedule and coordinate audit activities to ensure timely completion.
- Undertake additional duties as assigned.
Required Qualifications:
- High School Diploma / GED (or higher).
- 1+ year of auditing experience in customer service and claims.
- 3+ years of customer service Call Center experience in the healthcare industry.
- Intermediate proficiency in Microsoft Word, PowerPoint, and Excel.
- Excellent verbal and written communication skills.
- Strong analytical, decision-making, and problem-solving skills.
- Ability to manage multiple priorities independently.
- Demonstrated ability to organize material, analyze, and draw logical conclusions.
- Strong time management and organizational skills.
- Ability to prioritize workload to meet deadlines effectively.
- Adaptability to incorporate frequent changes into workflow.
- Strong interpersonal skills and ability to work independently and within a team.
- Proven understanding of basic quality principles and programs.
Essential Attributes:
- Experience with Smartsheet and intermediate knowledge.
- Understanding of intermediate to advanced Quality Programs.
- 2+ years of auditing experience.
- Six Sigma white belt certification.
- Experience in process narrative and mapping.
MPF Federal is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or on the basis of disability. We offer a competitive compensation package including a competitive salary, medical benefits, PTO, holiday pay, and more.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Experience level:
Schedule:
- Day shift
- Monday to Friday
Work setting:
Application Question(s):
- Do you have 1+ year of auditing experience in customer service, appointment scheduling, provider data load, and/or claims?
- Do you have 3+ years of customer service Call Center experience in the healthcare industry?
- Can you accept a salary range of $45,000-$48,000?
Work Location: Remote