Quality Review and Audit Senior Representative

YOUR JOB

As a Quality Review and Audit Senior Representative , you play a key role in safeguarding operational excellence across service delivery teams. You will be responsible for conducting quality audits, reviewing case accuracy, identifying process gaps, and ensuring adherence to internal procedures, regulatory guidelines, and customer commitments.

You will provide actionable feedback to team leaders and staff, support continuous improvement, and contribute to building a culture of quality, compliance, and consistency across Operations.

This role acts as a bridge between frontline teams, supervisors, and quality leaders by bringing insight, evidence-based recommendations, and root‑cause analysis into daily operations.

KEY RESPONSIBILITIES

Quality Review & Audit Execution

• Conduct routine and targeted audits across operational workstreams (e.g., Claims, Eligibility, Admin, Customer Service, Client Support).

• Assess accuracy, completeness, compliance, and alignment to SOPs and regulatory requirements.

• Review system entries, documentation, case handling, and communication quality.

• Ensure audit scoring is objective, consistent, and aligned with the quality framework.

Insights, Feedback & Coaching Support

• Provide clear, constructive audit feedback to team members and supervisors.

• Highlight high‑risk errors and recurring themes that require escalation.

• Support team leaders in delivering quality coaching sessions.

• Maintain accurate audit logs and records for reporting & governance.