Aug 16, 2022
Job Summary:
Responsible for the analysis of claims data to ensure compliance with customer’s business rules. Provides analysis for proper utilization of OMS, Camunda and Hyperscience to ensure timely and accurate rating of claims.
Essential Duties and Responsibilities:
• Document quality issues and performance measures for management review
• Analyze data and observations and write result summaries to validate deviations from existing standards
• Recommend modifications to existing standards, methods, or procedures
• Interact with field personnel and supervisors
• Review, analyze, and implement processes and report trends to promote customer satisfaction
• Conduct internal quality assurance of providers (medical professionals)
• Compile strategic information and develop reports to monitor quality effectiveness
• Ensure compliance and understanding of quality requirements
• Manage special projects and make recommendations as appropriate
• Perform...
QTC Management, Inc.
San Antonio, TX, United States
Full time