The QA Analyst is responsible for assisting, organizing and facilitating strategic program creation and implementation. This role assists in researching and compiling appropriate and relevant data and feedback for risk activities. This role also includes calibrating team member to meet best practices for our appeals and grievance department.

RESPONSIBILITIES:

Assists in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues Maintains comprehensive knowledge of business, products, programs (including Utilization and Case Management) corporate organizational structure (including functional responsibilities), and basic research principles/methodologies Assists in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters Assists in development of lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues Assists in identifying resolution of challenges and issues to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities Assists in development of plans, reports, papers, and/or other material creation as needed  Assists with research and correction of authorization rejects Attends and participates in a variety of meetings and committees to provide perspective for a business analysis perspective Researches and evaluates data from different sources to identify discrepancies and patterns Consults with the operations teams to validate content of reports and documents Assists with User Acceptance Testing (UAT) and other implementation tasks as needed Facililitates calibration meetings with team members Consults on updates to Desktop Level Procedures (DLPs) Track and trend patterns in production and monitor Key Performance Indicators (KPIs) Conducts internal audit of Appeals and Grievance cases including scoring of team members Assists in training new of hires and collaborate with team members to retrain identified discrepancies Primary point of contact as subject matter expert for appeals and grievances

QUALIFICATIONS/REQUIREMENTS:

Bachelor’s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or a related field. Relevant combination of education and experience may be considered in lieu of degree 3 years’ experience in a related field, typically in at least 2 of the following areas is preferred: financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management •Experience in healthcare • Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas • Ability to work independently within a team environment and communicate effectively with employees and clients at different levels • Flexibility and ease with changing tasks and priorities • Ability to perform technical tasks such as user training manuals and guides • Ability to verify accuracy, consistency, and integrity of data