Job Summary
Under general supervision, responsible for reviewing and evaluating Claim Operations functions and tasks for compliance with department procedures and regulatory requirements. Calibrates completed reviews with the Claim Operations Quality Manager, Claim Operations Quality Director and Process Analysts to identify best practice and opportunity areas.
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:

1. Completes quality reviews for assigned functions and tasks; gathers and synthesizes data necessary to enhance execution, process improvements and quality work.
2. Works with the Claim Operations Quality Manager and the Claim Operations Quality Director to aggregate and analyze results from quality reviews to identify trending of best practice and opportunity areas across the Claim Reporting and Support functions.
3. Periodically serves as support for the Claim Operations Quality Director by providing additional context to review results, supporting action plans for the business teams and partnering with the Claim Operations Process Analysts on employee training and process improvements.
4. Participates in Compliance related reviews, as necessary.
5. Stays current on industry trends and developments.

1. Strong knowledge of department workflows, processes and procedures related to tasks in Claim Operations.
2. Strong organizational skills with the ability to manage multiple tasks and work independently.
3. Strong attention to detail.
4. Strong, verbal, written, analytical, presentation and interpersonal skills.
5. Strong knowledge of Microsoft Office suite and other business related software.

1. Associates degree or equivalent experience.
2. Typically a minimum of one to two years of relevant business experience.