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Corporate Functions & Operations WellCare - Quality & Audit Careers

Quality & Audit Specialist - Senior Job

Full Job Title: Quality and Audit Specialist, Senior

Job Number: 1800372

Location: Tampa, FL

Date Posted: 2-8-2018

Department: Pharmacy - Quality

Reports to: Manager Quality and Audit

Location: 4110 George Road Tampa FL 33634

Performs complex and detailed quality audits to assess compliance with WellCare's contractual and regulatory requirements.

Essential Functions:
  • Conducts quality reviews on audits performed by the team.
  • Researches and performs root cause analysis and communicates the process improvement opportunity options.
  • Prepares ad hoc reports to summarize audit findings.
  • Facilitates meetings representing the Quality and Audit Team with internal and external business partners as needed.
  • Tracks and maintains quality results for appropriate distribution.
  • Acts as a subject matter expert for all audit questions and issues.
  • Acts as a mentor for the Quality auditors. Provides real-time feedback as appropriate for the job function.
  • May participate in training activities for new and establish team members as well as in special projects and in other duties as assigned.
  • Performs other duties as assigned.
Additional Responsibilities:
  • Coordinates and participates in the Enrollment data file extraction process (e.g: gathering of criteria, review and testing of data).
Candidate Education:
  • Required A High School or GED
  • Preferred A Bachelor's Degree in a related field
Candidate Experience:
  • Required 4 years of experience in Internal: a healthcare organization; preferably in Enrollment / Customer Service / CTM / Grievance processes.
  • Required 5 years of experience in External: a healthcare organization; preferably in Enrollment / Customer Service / CTM / Grievance processes.
Candidate Skills:
  • Intermediate Ability to multi-task
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Other Ability to remain calm under pressure
  • Intermediate Other Uses tact and diplomacy when performing job duties.
  • Intermediate Other Ability to perform detailed review, research and analysis to ensure Operational accuracy across multitude of systems.
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft PowerPoint

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Last Updated On: 12/9/2015