Summary description:

Job Family Description:Positions in this family support claim processing functions including investigations, negotiating settlements, payments, research regarding eligibility, etc.Job Function Description:Positions in this function are responsible for all aspects of quality assurance within the Claims job family. Conducts audits and provides feedback to reduce errors and improve processes and performance.General Job Profile:- Analyzes and investigates.- Provides explanations and interpretations within area of expertise.Job Scope and Guidelines:- Uses pertinent data and facts to identify and solve a range of problems within area of expertise.- Investigates non-standard requests and problems, with some assistance from others.- Works exclusively within a specific knowledge area .- Prioritizes and organizes own work to meet deadlines.- Provides explanations and information to others on topics within area of expertise.

Job description:

QMQI performs reviews based on established, documented processes. Provides feedback to area leadership on audit findings. Provide BPI suggestions to operational team and follow work instruction update process. Work on BPI teams with a lead or major role and or lead BPIs end to end. Respond to appeal and make corrections to audits. Provides feedback and or responses on audit results and corrective & preventative actions, based on identified defects.

Eligibility factors: