Audit Quality Specialist

Perform production and quality audits to ensure operations are effective, consistent and in compliance with business rules and processes. Primary focus includes, but is not limited to auditing the Document Specialists, Claims Document Analysts, Senior Document Analysts, Mail Clerks, and Inserter Operators. Responsible for performing administrative and support tasks which may be highly confidential and sensitive in nature.

PRIMARY RESPONSIBILITIES: (Brief bullet points detailing the major duties, not tasks, for this job and the % of time spent on each. Please list them in the order of importance).

Completes production and quality audits, reviewing completed work in comparison to established documented procedures to determine accuracy while providing support to staff as an acting SME.

• Orients new employees to the departmental and unit procedures.

• Collaborate with management and stakeholders to ensure understanding, alignment, and consistency in workflow performance.

• Partner with training, management, and stakeholders to identify training needs based on quality assessment results Compiles, creates, prepares, and reviews for accuracy, information and reports as requested or scheduled. This includes analyzing trends and data, creating reports.

· Reviews, investigates, and corrects documents routed to various error queues by multiple teams. · Provides individual and group support sessions and mentoring for all Records Management positions.

• Participates in review of process changes with a clear focus on the potential impact to quality, accuracy, and results.

• Provides feedback on comprehension and adoption of the training. May attend training sessions to understand changes to processes, regulations, and workflows.

• Reviews, evaluates, and makes recommendations for process improvements.

• Assists in the creation of departmental procedures and reference documents.

• May be required to perform work in the operations and/or service center teams along with Records Management or perform other activities in order to maintain or gain knowledge of current processes, procedures and systems relative to the areas of auditing for which they are responsible.

• Participates in projects as assigned.

• Perform audit related investigation to troubleshoot error trends as it relates to business processes and/or training. May be responsible for researching operational audit best practices and making recommendations for improvement.

• Maintains confidentiality of all information processed

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

A. EDUCATION REQUIRED:

Associate degree in insurance, business or a related field. Combination of relevant education and work experience may be considered in lieu of a degree.

B. EXPERIENCE REQUIRED:

Two (2) years experience with AF Group within the Claims, Business Development, Finance, Service Center, Records Management, or equivalent Enterprise experience that provides the necessary skills, knowledge and abilities.

OR

Three (3) or more years experience in an insurance organization which provides working knowledge in one or more of the following areas: records management, claims management, underwriting, finance or auditing.

C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Working knowledge of Workers Compensation claims, records management, and/or business development procedures, workflows, and rules for multiple states.

• Excellent analytical skills to identify opportunities for improvement and recommend solutions.

• Ability to comprehend consequences of various situations to make appropriate individuals aware of same for decision making.

• Strong analytical and problem-solving skills.

• Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information, and respond to questions as appropriate.

• Ability to read, analyze and interpret policy documents, technical, legal, and financial information, and procedures manuals.

• Excellent verbal and written communication skills.

• Ability to manage multiple projects and meet necessary deadlines.

• Basic knowledge of computers, spreadsheet software, and word processing and ability to enter accurately 50 WPM.

• Ability to perform mathematical calculations.

• Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format and edit as necessary.

• Ability to maintain confidentiality.
  

D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:

• Ability to create surveys and survey criteria.

• Completion of industry recognized quality or internal audit certification(s).

• Advanced knowledge of industry best practices related to sound internal controls and audit techniques.

• Ability to assist in the development and implementation of policies, practices, and procedures.

• Bachelor’s degree in business.

• Insurance education coursework.

• Certification or progress toward certification in courses focused on but not limited to Quality Auditor, Quality Manager, Six Sigma, or other quality designations is highly preferred and encouraged.
  

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Ability to lift up to 40 lbs. Minimal travel.

REQUIRED TESTING:

Basic Excel, Reading Comprehension, Math, Typing 50wpm, Proofreading, Basic Word, and Basic Windows.