Healthcare Quality Mgmt Consultant

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.