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Quality and Process Improvement Lead

4 hours ago
United States
Full-time
Lead
Manual QA Tester
Quality Assurance and Testing
Machine Learning
Apply Now
Dane Street

Dane Street

Dane Street provides independent medical examination and peer review services tailored for the insurance industry, focusing on areas such as workers' compensation, disability, and auto liability, while emphasizing quality, compliance, and timely delive...

Insurance
251-1K
Founded 2008
View All Jobs 35

Description

  • Partner with client auditors in monthly reviews and calibration sessions to align expectations and reduce scoring variance.
  • Select monthly case samples, reconcile scores, and document audit results in client systems.
  • Lead audit rebuttals by investigating findings and presenting timely, data-supported appeals.
  • Maintain and analyze quality metrics, audit insights, compliance trends, and team performance data.
  • Lead client touchpoints and business reviews focused on compliance standards and partner satisfaction.
  • Coach QA teams on client specifications, scoring criteria, and quality standards.
  • Analyze audit trends, investigate root causes, and recommend corrective process improvements.
  • Track post-audit action plans, process updates, and machine learning enhancements.
  • Collaborate with technology and operational teams to develop and validate automation rules and ML tools.
  • Create calibration programs, SOPs, case guidelines, and CAPA protocols for recurring quality or compliance issues.
  • Establish reporting for leadership on risk areas, implemented solutions, and performance gains.

Requirements

  • Associate’s degree or equivalent experience.
  • Experience in quality assurance, auditing, utilization review, or related healthcare operations.
  • Working knowledge of workers’ compensation utilization review processes and requirements.
  • Knowledge of ODG, MTUS, and other jurisdiction-specific clinical guidelines.
  • Ability to interpret client requirements, audit criteria, scoring methodologies, and quality standards.
  • Strong analytical, discrepancy investigation, trend analysis, and root-cause analysis skills.
  • Ability to translate audit findings into process improvements and corrective actions.
  • Experience providing quality feedback, coaching, or education to operational teams.
  • Strong written and verbal communication skills with internal leaders and external clients.
  • Strong attention to detail and ability to manage audits, deadlines, documentation, and follow-up independently.
  • Proficiency with Microsoft Office, reporting systems, audit platforms, and case-management tools.
  • Ability to collaborate across Operations, Quality, Technology, and other teams.
  • Ability to travel up to 10%.
  • Three or more years of QA experience supporting the relevant client or clients preferred.
  • Ability to work remotely with a reliable, uninterrupted internet connection and self-supplied internet service.
  • Ability to remain seated and work at a computer for extended periods; occasional handling of equipment or files weighing 10–15 pounds.

Benefits

  • Medical, dental, and vision coverage for employees and families.
  • Voluntary life, hospital indemnity, critical illness, accident, and pet insurance options.
  • Company-paid basic life, short-term disability, and long-term disability coverage.
  • Generous paid time off policy.
  • 401(k) plan with company match.
  • Remote work culture with Apple equipment and a media stipend.
  • Professional growth, employee development, and comprehensive benefits.

Interested in this position?

Apply directly on the company website

Apply Now

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