Quality Audit Specialist

Summary

Join Included Health as a Quality Audit Specialist (QAS) and contribute to our mission of supporting client quality audits and fostering continuous readiness across service lines. This role involves supporting pre-audit workflows, real-time audit coordination, and post-audit activities. You will leverage data-driven insights to identify trends and risks, escalating concerns to leadership and proposing improvements. The ideal candidate possesses a passion for service excellence, strong analytical skills, project management experience, and exceptional interpersonal abilities. You will be responsible for utilizing resources to proactively identify audit readiness gaps, providing training on audit processes, and supporting remediation plans. This position reports to the Senior Manager, Quality Audit & Knowledge Enablement.

Requirements

• 3+ years of quality or data analysis and interpretation experience
• College degree or equivalent experience
• Experience managing projects
• Experience utilizing quality improvement frameworks and leading quality improvement efforts
• Strong interpersonal skills and the ability to build positive relationships with employees at all levels of the organization
• Passionate about excellence in customer service
• Analytical mindset with the ability to interpret data and derive actionable insights
• Must work well under pressure with a proactive approach including managing multiple deadlines and priorities
• Self-starter with ability to quickly pick up new content and processes in a fast-paced, dynamic work environment
• Ability to create reports, dashboards and visualizations
• Experience with Google Workplace platform and Mac OS

Responsibilities

• Utilize resources and tools to routinely "test the system" for audit readiness, proactively and in real-time identifying gaps
• Analyze, synthesize, and communicate insights to Member Care and Clinical leadership
• Provide education and training on audit processes and procedures to cross-functional teams, ensuring readiness to meet audit criteria
• Provide education and guidance regarding gaps surfaced in audits and call listening sessions, in partnership with Member Care Operations, Member Care and Clinical leadership
• Deploy the audit playbook for each audit
• Facilitate distribution of materials supporting audit activity, both internally- and client-facing
• Support and/or lead internal meetings associated with an audit
• Document learnings and findings throughout the audit lifecycle
• Support remediation plan through identification of and collaboration with designated remediation owners plus tracking to tasks and timelines
• Document audit findings to include recommendations for operational, clinical, product, go to market and other teams as appropriate
• Track and trend remediation efforts coupled with findings across all client audits
• Support involved leadership teams in post-audit activities

Preferred Qualifications

Previous health care experience

Benefits

• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
• Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents
• Generous Paid Time Off ("PTO") and Discretionary Time Off ("DTO")
• 12 weeks of 100% Paid Parental leave
• Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance
• Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)
• 11 Holidays Paid with one Floating Paid Holiday
• Work-From-Home reimbursement to support team collaboration and effective home office work
• 24 hours of Paid Volunteer Time Off ("VTO") Per Year to Volunteer with Charitable Organizations