TOP Quality Auditor

Overall Purpose of the Role

The role of the Quality Auditor is to support the Quality Management System (QMS) by completing monthly quality process audits and developing monthly trending and analysis reports with a focus on improving service delivery to TRICARE beneficiaries and MTF stakeholders through our Beneficiary Support Center and LAC Regional Contact Center. 

This role is also responsible for monitoring customer experience (CX) feedback, tagging key themes for accurate trend analysis and supporting the operations and Near Patient Teams to close the loop with beneficiaries where required. As part of this role, the Quality Auditor will manage the TOP Global Quality Inbox, log customer feedback (compliments, complaints, grievances) into the customer feedback system and escalate issues in a timely manner to other team members and / or to the Clinical Quality Team. The Quality Auditor will also participate in quality improvement initiatives to improve the overall quality of our service and learn how to structure effective initiatives through the Plan, Do, Check, Act model. The Quality Auditor will be a key contributor to the design of effective and relevant process audit tools, including call review audit tools, case  management audit tools and correspondence audit tools. 

The Quality Auditor role is an entry-level quality role and a great opportunity to learn how an audit program can play a vital part in managing quality; as well as learning key tenets of how a comprehensive Quality Management System (QMS) is structured and functions. Coaching and development will be provided, and it is envisaged that this role is a steppingstone to a career within quality. The Quality Auditor role will support all three TRICARE Regions and hence has a global remit.

Key Responsibilities

• Performs daily quality process checks and audits of TRICARE service delivery, including monitoring of inbound and / or outbound telephone calls, audits of key processes that form part of requests for medical referrals to network/non-network providers, claims / enrolment / payment enquiries, or any queries coming into a Regional Contact Center.
• Records findings from process audits, monitors trends and identifies root causes and opportunities for improvement.• In collaboration with the wider quality team, contributes to the data-driven development of effective action plans for driving improvement. 
• Provides feedback to managers regarding areas for improvement and recommends coaching opportunities for individual team members. May also provide feedback and coaching directly to individual team members as required.
• Prepares monthly quality reports according to TRICARE Contract Data Requirements List and / or internal reporting guidelines.
• Daily monitor of the Quality Assurance Inbox, which includes escalating issues to other team member where required, logging new customer feedback (complaints, compliments, grievances) within the customer feedback system and updating any existing records based on feedback from investigating parties (beneficiaries, POC / MTF / TAO, Program Managers, TRICARE Provider Support Services, WPS, Leidos, Near Patient Teams, Clinical Quality Teams)
• Attends and actively participates in monthly call calibration sessions with the appropriate stakeholders from TRICARE service delivery. Supports to schedule and administrate these sessions.
• Attends and actively participates, by discussing noted trends or intuitive observations, in Training Needs Analysis Meetings and Regional or Local Quality Forums.
• Participate with Operational and Medical departments in developing Standard Operating Procedures (SOPs) with concurrence of appropriate TOP managers. These must conform to any similar corporate SOPs. 
• Performs case quality management reviews 
 

KEY PERFORMANCE INDICATORS
• Beneficiary Satisfaction
• MTF Satisfaction
• Quality Targets and KPIs achieved to plan
• LAC Regional Contact Center Attrition
• Audit schedules on time
• Reporting accurate and timely
• Process improvements well-structured and meaningful / impactful
• Development plan agreed and fulfilled 

Required Qualifications

Required Skills and Knowledge (Brief description of technical knowledge or skills needed to perform the job)
• Knowledge or familiarity of TRICARE Overseas Program is highly desirable
• Attention to detail
• Ability to communicate verbally with clarity, brevity and accuracy
• Ability to provide clear and concise written updates
• Ability to work collaboratively across teams/functions
• Identifies and acts on potential problems and / or difficulties. 
• Demonstrates effective problem solving skills and lateral thinking. 
• Ability to work under pressure
• Task prioritization and task-switching
• Demonstrate appropriate listening skills
• Demonstrate appropriate spelling and grammar
• Knowledge of NPS methodology advantageous
 

Required Work Experience (Brief description of the job-related experience needed to perform the job)
• Some experience working in a quality role, preferably in healthcare, claims, insurance or contact center environment.
• Proficiency in Microsoft Office applications, specifically MS Word and MS Excel
• Knowledge of TRICARE Overseas Program preferred, but not required 
 

Required Qualifications and Education (Brief description of the educational background needed to perform 
the job)
• Bachelor’s Degree preferred.
• This position does require someone who can obtain and maintain the appropriate level of tiered 
investigation access for a position of Trust after being offered a position. International SOS will facilitate
 

Required Languages (Brief description of the language skills needed to perform the job)
• English language required
• Spanish language desirable but not required
 

Travel / Rotation Requirements (Brief description of any travel or rotation requirements)
• This position may require travel to other TOP regions to support in audits and quality initiatives

This job description outlines the types of responsibilities the incumbent is required to perform. The incumbent may be required to perform job related tasks other than those specifically presented in this job description. This job description is subject to regular review.

International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.