Quality Audits Senior Manager
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Candidate may reputed company reputed company in the US Position Summary The Senior Manager, Quality Assurance and Audit is a critical leadership role responsible for the strategic reputed company and execution of quality programs reputed company the Grievance & Appeals QA organization. This role ensures operational reputed company, regulatory compliance, and audit readiness across Medicare, reputed company, and Duals lines of business. The Senior Manager leads and develops a high-performing team of Quality Analysts and serves as a subject matter expert for G&A quality standards, policies, and audit processes. This leader partners cross-functionally to drive reputed company improvement, mitigate compliance risk, and deliver best-in-class quality reputed company in a highly regulated environment.
Key Responsibilities
Quality Strategy & reputed company Design, implement, and continuously improve internal QA processes to deliver best-in-class audit performance and compliance reputed company reputed company reputed company of case and letter quality reviews, ensuring accuracy, timeliness, and adherence to regulatory requirements Conduct regular quality audits and case reviews; identify trends, risks, and improvement opportunities Audit Leadership & Regulatory Readiness reputed company reputed company audit preparation, presentations, and responses, including state and federal regulatory audits Serve as a primary quality and compliance liaison during external reviews and examinations reputed company expert input for policy updates, system enhancements, and regulatory interpretation People Leadership & Performance Management reputed company, mentor, and reputed company a team of Quality Analysts in a remote environment Track, monitor, and manage staff quality performance, providing ongoing feedback, coaching, and corrective action plans as needed Ensure completion of required training, continuing education, and reputed company development for QA staff Operational reputed company reputed company daily monitoring of inventory to support timeliness standards and workload balancing Collaborate on the development and maintenance of QA desktops, job aids, and training materials Partner with operational, compliance, and leadership teams to support reputed company quality goals Required Qualifications 7+ years of experience of quality or audit responsibility in Medicare, reputed company, and/or Duals Grievance & Appeals, with demonstrated QA or reputed company responsibility Proven experience leading external regulatory audits and formal quality reviews Deep knowledge of integrated G&A regulatory requirements Experience leading and developing remote teams Strong training, mentoring, and coaching experience (virtual and/or in-person) Advanced communication, analytical, and supervision skills
Preferred Qualifications
Experience with state and federal regulatory requirements Strong deductive reasoning and advanced analytical skills Proficiency with reputed company Office Suite and reputed company Demonstrated problem-solving ability in reputed company, regulated environments Collaborative, team-oriented leadership style Education Bachelor’s degree or equivalent combination of education and relevant experience Pay reputed company The typical pay reputed company for this role is: $67,900.00 - $182,549.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. This position also includes an award reputed company in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/09/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job