Healthcare Quality Mgmt Consultant

SGS_JOB_1806

Business Support
Remote
audit or underwriting
Salesforce

Contract - 03+ Months (Contract)

Candidate will need to work +/- 1 hour of the AZ time zone, but can reside anywhere in the US. As a Quality Auditor you will be part of our PBM Underwriting Quality Management Team. This position will provide strategic support to the department and execute new processes to mitigate risk. The primary focus of the role is to perform various audits and report on status, results, and trends. As an individual contributor, you will have the opportunity to showcase your strong attention to detail, your sense of urgency, and show how highly organized you are with competing priorities. You will also identify improvement areas for quality control, present recommendations, and bring improvements to fruition. This position will work closely with cross-functional business partners at all levels of the organization.

Job Responsibilities:

  • Collaborate with underwriting, sales, data science, and audit teams to conduct quality audit reviews on a variety of business documentation, processes, and systems. Audit types include but are not limited to the following, SOX audit, peer review audit, sales review audit, signed contract review audit.
  • Drive automation and reporting tools to streamline quality reviews and enhance data transparency.
  • Promptly resolve issues related to audit findings and provide status updates to leadership throughout audit process, e.g., from audit completion through audit finding resolution.
  • Work closely with Business Analytics to identify patterns of procedural errors and improvement areas and to develop actionable solutions.
  • Present quality insights, metrics, and recommendations to senior leadership in a clear, data-supported format.
  • Maintain data-driven KPIs and quality scorecards to monitor underwriting performance, consistency, and compliance.
  • This role requires someone with superior organizational skills, logic and problem-solving skills, including high level of attention to detail and the ability to deliver on multiple and competing priorities.

Skills:

  • 1+ year of audit or underwriting experience, including at least 1 year in a quality assurance capacity.
  • 1+ year of experience using Salesforce.
  • Background in PBM industry.

Education/Experience:

  • Bachelor’s degree in Business, Finance, Risk Management, Legal, or comparable work experience in a related field.

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