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We are seeking a detail-oriented and analytical Quality Assurance Specialist to join a fast-paced operations team supporting healthcare and government service programs. This role is responsible for conducting quality reviews across multiple functional areas, identifying trends, ensuring compliance with established standards, and driving continuous improvement initiatives. The ideal candidate will have strong organizational skills, excellent communication abilities, and the ability to work independently while maintaining accuracy and confidentiality. Experience in healthcare operations, Medicaid, CHIP, or public sector services is highly preferred.
Job Responsibility:
Conduct quality reviews across multiple functional areas to ensure compliance with operational standards and procedures
Perform objective, accurate, and concise quality assessments with a strong focus on continuous improvement
Maintain quality performance standards, including a monthly quality score of 96% or higher and an approved challenge percentage below 5%
Meet productivity standards for assigned functional areas
Develop and maintain a strong understanding of all operational workflows and serve as a resource for program knowledge
Identify trends, recurring issues, and opportunities for process improvement
Update and maintain quality monitoring systems to track assessment data and reporting
Assist with implementing and maintaining quality assurance processes, controls, and best practices
Monitor and ensure staff complete required corrections from returned quality assessments
Perform administrative tasks to support quality team objectives and business operations
Support additional departments as needed
Complete special projects and other duties as assigned
Requirements:
Experience in government services, consumer services, healthcare operations, or health and human services preferred
Public sector healthcare experience strongly preferred
Medicaid and/or CHIP program experience is a plus
Previous experience in quality assurance, compliance, auditing, or operational review preferred
College degree preferred
Strong verbal and written communication skills
Excellent interpersonal skills and ability to work effectively within a team environment
Strong analytical, organizational, time management, and problem-solving abilities
Ability to produce accurate and high-quality work under deadlines
Self-motivated with strong initiative and the ability to manage multiple priorities
Comfortable working in a fast-paced environment with changing processes and guidelines
Ability to work independently and maintain confidentiality regarding quality assessments
Proficiency in Microsoft Word, Excel, and Outlook
Minimum typing speed of 30 WPM
Bilingual skills preferred
Strong commitment to service, professionalism, and continuous improvement