JOB SUMMARY

The primary purpose of this position is to identify, analyze and improve quality, to ensure delivery of SLA quality metrics per client contract. This includes but is not limited to auditing, creating & reviewing quality reports, trending and analyzing audit findings, answering agent questions, client communications, training, continuing education programs assisting in the development of employees so they can keep pace with the changing needs of the organization, and to ensure that processes are in place to meet the goals and objectives of the client and the organization.

QUALIFICATIONS REQUIRED:

• High school diploma or equivalent required
• 2 to 3 years of relevant Domain/Industry experience [Manual Claim adjudication] with at relevant experience in claims auditing is preferred.
• Should know end to end claims adjudication for first pass and adjustment claims
• Should know how to follow and utilize Molina SOPs
• AZ and/or WA BH Medicaid knowledge preferred
• Identify and analyses Quality assurance issues and recommend appropriate solutions
  We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state, or local law.
  It is the policy of this Company to seek and employ qualified individuals at all locations and facilities, and to provide equal employment opportunities for all applicants and employees in recruiting, hiring, placement, training, compensation, insurance, benefits, promotion, transfer, and termination. To achieve this, we are dedicated to taking affirmative action to employ and advance in employment qualified individuals with disabilities, disabled veterans, and other eligible veterans.

• Work with minimal supervision using professional skills, discretion and sensitivity while addressing various quality and training issues.
• Work as a team member in determining departmental needs.
• Serve as a resource for employees and management.
• Provide quality review and training for the further development of each employee.
• Work well with a variety of individuals and resolve issues professionally.
• Be a leader who interfaces with various operations management personnel.
• Provide timely quality follow-through in the form of audits and development sessions.
• Performs other work-related duties as assigned.