Quality Assurance Analyst I

Network Health's success is deeply rooted in its mission to build healthy and strong Wisconsin communities. This mission shapes every decision we make, including the selection of individuals who join our growing team.

The Quality Assurance Analyst I is responsible for identifying quality inefficiencies within the Member Experience call center by monitoring organizational processes, promoting service excellence, and ensuring compliance with quality and operational standards. Key responsibilities include reviewing calls, claims, and other monitoring activities across multiple lines of business. This role conducts weekly and monthly evaluations, reports findings, and supports the development, implementation, and ongoing assessment of quality assurance policies and procedures.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both with our hybrid workplace model.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities

• Performs data entry, claim, and call monitoring activities and scores performance according to set criteria and timelines
• Perform other operational audits and scores performance according to set criteria and timelines.
• Trends monitoring results and provides feedback to the Manager of Quality Assurance
• Compiles results into meaningful, actionable reports with recommendations for process improvements
• Documents findings and makes recommendations for efficiencies based on monitoring results
• Responsible for accurate and timely performance of monitoring activities
• Maintains and updates tracking databases and/or files to support monitoring activities
• Ensures quality assurance process documentation remains up to date
• Other duties as assigned

Job Requirements:

• Associates degree or equivalent work experience required
• Bachelor's degree preferred
• 3 or more years of experience working in healthcare or health insurance.
• One or more years of experience working in one or more of the following: claims, customer service, billing/coding, appeals and grievances or another data entry related position required.