Director of QA & Compliance (Finance)

The Director of Quality Assurance & Compliance is responsible for managing the Quality Assurance function across all business lines. This role involves supporting the business's strategic objectives and meeting the broader corporate quality assurance, internal and external audit, and compliance requirements. The position will collaborate with call center, claims, and other operational leaders, as well as the Compliance and Internal Audit teams, to enhance the efficiency and accuracy of transactions.          

Description      

·         Continuously develop and implement quality assurance programs to ensure accuracy and efficiency in call center operations, claims processing, and enrollment and billing based on business needs.        

·         Optimize quality programs to utilize more automated tools and critically focus on system assessments to improve system throughput.    

·         Accountable for all operational transaction auditing associated with regulatory compliance audits and client Performance Guarantees (PGs) reporting.           

·         Establish a collaborative partnership with internal business partners to facilitate problem-solving, provide root cause analyses, and maintain operational oversight to reinforce high-quality performance.

·         Champion and own cross-functional remediation of issues and process improvements as necessary.

·         Monitor and provide operational performance metrics and additional trend analysis to monitor operational metrics on daily, weekly, and monthly basis.          

·         Actively manages professional development of direct reports and provides motivation, recognition, and leadership through coaching, counseling, and performance appraisals.          

·         BA/BS in Information Systems, Computer Science, Business Administration, Data Analytics, or related field or equivalent experience.               

·         Minimum of 7-10 years of experience in quality assurance and compliance within the health insurance industry.             

·         In-depth knowledge of health insurance regulations, including HIPAA, ACA, and other relevant regulations.      

·         Proven track record of successfully managing quality and compliance programs. Strong experience in insurance claims handling and administration

·         Thinks creatively; seeks out and explores alternative approaches to problem solving and the identification of potential solutions.    

·         Very strong analytical and technical skills in using data analytics to investigate root causes for deficiencies and effectiveness of controls