Quality Assurance Specialist II

Position Purpose: Assesses the quality of departmental interactions, systems, and relevant processes through a variety of communication channels to ensure compliance of established policies and procedures are met. Works with cross functional departments to correct and improve routine quality concerns and processes.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Experience with Medicare, grievance, and CTM is highly preferred.

Experience in auditing, analytical skills, and root cause analysis is highly preferred.

Great time management, organization skills and attention to detail is preferred.

• Monitors, inspects, and assesses the quality of interactions, systems, and processes to achieve established quality standards
• Documents and reports on the quality, performance, and remediation efforts/progress of risks for leadership review and audit purposes
• Identifies improvement opportunities and provides guidance material to improve department processes
• Utilizes technology to continuously monitor and report on customer interaction performance
• Supports in preparing and distributing internal audit reports and findings to provide knowledge on quality improvements
• Assists as needed in coordinating document and data control (e.g., version control and numbering) to ensure accuracy and completeness
• Supports with random quality assurance checks to ensure compliance
• Upholds quality assurance policies and procedures and provides guidance or remediation plan when required
• Supports process improvement opportunities (process or technology) to continuously increase efficiency and effectiveness
• Assist with servicing members and/or providers as needed
• Actively participate in quality calibration sessions with quality team
• Assists with training of new hires as needed
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. May require vocational or technical education in addition to prior work experience. Vocation or technical education may include additional on-the-job training or continuous learning education.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Originally posted on Himalayas