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Corporate Functions & Operations WellCare - Quality & Audit Careers

Quality Analyst - Operations Job

Full Job Title: Ops Quality Analyst

Job Number: 1804248

Location: Tampa, FL

Date Posted: 2018-06-15

Responsible for performing high-level reporting, engaging in predictive trend analysis and making subsequent business process improvement recommendations for customer service and provider operations.

Essential Functions:
  • Research, understand, problem solve and report root cause of metric variances and propose possible business solutions.
  • Serve as subject matter expert regarding all process flows including understanding systems used and functions performed within each work type, dependencies/interactions and identification of potential impact resulting from changes
  • Assist in maintaining all project-related matters (e.g. action plans, tracking tools) and reporting to senior leadership as appropriate.
  • Responsible for leading cross-functional departmental planning sessions, and ensuring appropriate action planning results are executed.
  • Represent department in various task forces/committees, and presenting to executive and other senior leadership.
  • Coordinate project activity and facilitate project meetings with staff and inter-departmental partners.
  • Develop and maintain interdepartmental relationships to ensure proper involvement, cooperation and communication of changes are executed appropriately.
  • Builds and maintains positive business relationships with business partners at all levels of the organization, including executives.
  • Ability to support concurrent projects in an organized manner and meet agreed upon SLAs.
  • Participates in the formulation of project time estimates, and leverages cross-functional relationships.
  • Ensures adherence to quality processes and procedures.
  • Assist in the development and maintenance of various policies and procedures affecting the operations of the department.
  • Develops ad-hoc reports to conduct data analysis and validation.
  • Perform on-demand, rapid data analytics and reporting of multiple inputs/sources.
  • Develop and maintain comprehensive reports providing management with visibility to processor/team productivity and other departmental metrics.
  • Develop, document and implement process improvement opportunities.
  • Analyze trends, identity opportunities and recommend process and/or operational improvements.
  • Researches methodologies and conducts advanced metric reporting.
  • Provide ongoing operational analysis of process components, while identifying and implementing changes as necessary to improve the level of quality and efficiency as measured by key performance indicators.
  • Responsible for capturing and documenting metrics in support of the user acceptance testing and recommends improvements.
  • Assist in system requirements gathering and testing to ensure accuracy across systems.
  • May also assist in preparing various management related reports.
  • Perform all other related duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred A Bachelor's Degree in a related field
    Candidate Experience:
    • Required 3 years of experience in reporting, metrics analysis, quality and/or related function
    • Required 2 years of experience in working on interdepartmental projects
    • Preferred Other Health care analytics
    • Preferred Other Wellcare system knowledge
    Candidate Skills:
    • Intermediate Demonstrated analytical skills Ability to perform detailed review, research, and analysis to ensure accuracy of enrollment process in to Peradigm system
    • Intermediate Ability to analyze information and covert related activities into a comprehensive work plan
    • Intermediate Other Demonstrated technical expertise in performing quality reviews with analysis of results
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Advanced Other MS Office, including Excel, Powerpoint and Word

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        Last Updated On: 12/9/2015