Healthcare Quality Mgmt Consultant Job at SGS Consulting, Remote

  • SGS Consulting
  • Remote

Job Description

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.

Job Tags

Contract work, Work experience placement

Similar Jobs

Houston Methodist

Cancer Center - Research Coordinator II Job at Houston Methodist

At Houston Methodist, the Research Coordinator II position is responsible for coordinating the day-to-day activities of research protocols as well as assessing and determining qualification of patients for research studies. Under minimal supervision, this position is... 

Bright Vision Technologies

Senior Data Engineer - Hadoop Job at Bright Vision Technologies

 ...an established and well-respected organization offering tremendous career growth potential. Job Title: Senior Data Engineer - Hadoop Location: 100% Remote (U.S.) Position Type: Full-time, Direct W2 Salary Range: $145,000$165,000 Annually Experience Required... 

Lucile Packard Children's Hospital Stanford

Nurse Practitioner / Physician Assistant / Certified Nurse Midwife, OBG Fertility Services Job at Lucile Packard Children's Hospital Stanford

 ...and appropriate therapies. JOB SUMMARY This paragraph summarizes the general nature, level and purpose of the job. Nurse Practitioner (NP): The Nurse Practitioner functions under the general Nurse Practitioner Standardized Process Protocol approved by the Interdisciplinary... 

Central Taco

Assistant Manager Job at Central Taco

This job posting is for a position in a restaurant owned and operated by an independent franchisee not Del Taco LLC. This means the independent franchisee and not Del Taco LLC will be your employer if you are independent franchisee isresponsible for all employment related...

NTT DATA, Inc.

Coupa Administrator / Techno-Functional SME - Procure to Pay (P2P) Job at NTT DATA, Inc.

 ...organization, apply now. We are currently seeking a Coupa Administrator / Techno-Functional SME - Procure to Pay (P2P) to join our team...  ..., with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our...