Operations Quality Assurance Analyst

The Operations Quality Assurance Analyst ensures that Operations workflows, systems, policies, and procedures meet company standards, DDPA requirements, and industry regulations. This role involves reviewing, testing, and analyzing various aspects of Delta Dental of Colorado, including claims processing, customer experience, provider relations, and Clinical Management. The Analystroleidentifiesareas of opportunity and service excellence within the Operations departments to mitigate or maximize risk related to financial liability, membership retention, and acquisition.

This position is crucial in ensuring that Operations practices conform to both internal and external industry standards.

• High school diploma or equivalent is required.
• Previous experience in data analysis, including input, maintenance, qualitycontroland extraction of data is strongly preferred.
• One year of experience in a DDCO Operations department is strongly preferred.

• Strong written and verbal communication skills with the ability to effectively communicate with all levels of staff.
• Strong quality assurance knowledge for a health insurance company (dental or medical preferred).
• Strong working knowledge of current DDCO Operations workflows,systems and policies and procedures including but not limited to Claim Processing, Customer Experience,Clinicalstronglypreferred.
• Exceptional multitasking, critical thinking, attention todetailand analytical skills are required.
• Working knowledge in Salesforce and experience with databasesystemsuch as tableau or Power BI is strongly preferred.
• Working knowledge of dental insurance industry terminology and services preferred.
• Ability to gather,analyze,and synthesize information and data from multiple sources.
• Excellent organizationalandtime managementskillswith the ability tohandle multiple priorities and prioritize and schedule accordingly.
• High levelof integrity and discretion in handling confidential information.
• Excellent interpersonal and communication skills.
• Strong problem-solving skills and the ability to adapt to changing priorities.
• Ability to work independently and collaboratively in a team environment.
• Intermediate knowledge of the most recent version of Microsoft Office suiteusing
  
  Outlook,Word,Excel,PowerPoint,and Teams.

• Conduct and prepare detailed QA audits focused on workflows and internal processes at the departmental level and F inancial Accuracy auditsreported outquarterly for Performance gua rantees and DDPA exam . Present audit findings and actionable recommendations for improvement to DDCO leadership, ensuring alignment with company standards and industry regulations.
• Create and distribute comprehensive Quality Assurance Reports on a monthly, quarterly, annual (including fiscal year), and ad hoc basis. Summarize individual and departmental audit results and present them to management regularly. Collaborate with the Audit, Risk, and Compliance Services team for client-specific audit requests.
• Maintain a thorough understanding of Operations departments and workflows to inform quality assurance best practices. Continuously update knowledge to stay current with changes and improvements in operational processes.
• Work closely with other departments toidentifyand resolve benefit, product, and provider workflow issues within the Payor system.
  
  Communicate effectively with team members to ensure timely resolution and continuous improvement.
• Maintain and enhance existing audit processes, and develop new ones as needed to improve service levels and performance guarantees. Ensure audit processes are robust, efficient, and aligned with organizational goals.
• Collaborate with Learning and Development and HR to develop feedback loops for training and hiring new team members. Provide recommendations for training programs, new policies, and system changes to enhance team performance and operational quality.
• Plan, coordinate, and execute in-depth organizational processor audits and side-by-side evaluations to ensure adherence to quality standards andidentifyareas for improvement.
• Review and update quality assurance policies and procedures. Interpret and implement quality assurance standards and evaluate their adequacy in partnership with the Operations Program Manager.
• Prepare detailed QA audit findings at the departmental level and make recommendations for improvement to DDCO leadership. Ensure findings are well-documented and actionable.
• Routinely…