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Quality Audit Analyst

Job Summary

The Quality Audit Analyst is responsible for maintaining high standards of quality, accuracy, and compliance across operational service delivery teams. The role involves conducting detailed quality audits, reviewing completed cases, evaluating adherence to standard operating procedures (SOPs), regulatory requirements, and internal quality standards, while ensuring customer commitments are consistently met. The successful candidate provides constructive feedback, identifies process gaps and compliance risks, supports continuous improvement initiatives, and works closely with operational teams to enhance service quality, operational efficiency, and customer satisfaction. The role also contributes to building a culture of accountability, consistency, and operational excellence by providing data-driven insights and supporting quality improvement programs.

Key Responsibilities

1. Quality Review and Audit Execution

• Conduct routine, scheduled, and targeted quality audits across operational workstreams, including Claims, Eligibility, Administration, Customer Service, Client Support, and other assigned functions, to verify compliance with established quality standards.

• Review completed cases, system records, documentation, customer interactions, and operational processes to assess accuracy, completeness, consistency, and compliance with internal procedures, regulatory requirements, and customer service expectations.

• Evaluate the quality of case handling by ensuring that all operational activities are performed in accordance with approved Standard Operating Procedures (SOPs), company policies, and applicable industry regulations.

• Verify that system entries, customer records, supporting documentation, and communications are complete, accurate, and properly maintained to support operational integrity and audit readiness.

• Apply quality audit scorecards objectively and consistently while ensuring that audit results accurately reflect performance against established quality frameworks and operational standards.

• Maintain fairness, consistency, and transparency throughout the audit process by applying the same quality standards across all operational teams and individual employees.

2. Audit Feedback, Insights, and Coaching Support

• Provide timely, accurate, and constructive audit feedback to team members, supervisors, and team leaders to support continuous learning and performance improvement.

• Clearly explain audit findings by highlighting strengths, identifying areas requiring improvement, and providing practical recommendations that support better quality outcomes.

• Identify recurring quality issues, operational trends, and high-risk errors that may affect customer experience, compliance, or operational performance and communicate these findings to relevant stakeholders.

• Support supervisors and team leaders during quality coaching sessions by providing audit evidence, performance insights, and recommendations that promote employee development and improved service delivery.

• Maintain complete and accurate audit records, quality logs, and supporting documentation to ensure proper governance, reporting, and future reference.

3. Risk Management and Compliance Support

• Identify operational risks, quality concerns, compliance gaps, and potential regulatory breaches during audit activities to support effective risk management.

• Escalate critical audit findings, significant quality failures, or compliance issues promptly to Quality Leads, supervisors, and other relevant stakeholders for immediate corrective action.

• Support compliance with internal control requirements, governance standards, regulatory obligations, and organizational quality assurance policies.

• Monitor adherence to company procedures and quality standards to ensure operational activities remain compliant with internal and external requirements.

• Assist in minimizing operational risks by identifying weaknesses in existing controls and recommending appropriate corrective actions.

4. Continuous Improvement

• Recommend practical improvements to operational processes, workflows, documentation, and quality procedures based on audit findings and recurring performance trends.

• Support the review and updating of Standard Operating Procedures (SOPs), quality guidelines, and work instructions whenever audit results indicate opportunities for improvement.

• Identify opportunities to automate repetitive quality processes or introduce more efficient audit practices that improve productivity while maintaining quality standards.

• Participate in quality improvement initiatives, operational projects, working groups, and process enhancement activities aimed at improving service delivery and operational effectiveness.

• Share audit insights with relevant stakeholders to support informed decision-making and continuous organizational improvement.

5. Data Analysis and Reporting

• Define and monitor outcome-based quality metrics that accurately measure operational performance, audit effectiveness, and service quality.

• Compile quality reports, audit summaries, performance dashboards, monthly reports, quarterly reports, and trend analyses that provide meaningful insights to management.

• Analyze audit results, error patterns, recurring issues, and quality trends to identify root causes of operational challenges and recommend corrective actions.

• Support the preparation of Management Operating Reviews (MOR), audit reports, governance reports, and performance presentations using accurate quality data.

• Maintain reliable audit data and reporting records to support quality assurance activities and organizational decision-making.

6. Cross-Functional Collaboration

• Work closely with supervisors, trainers, Subject Matter Experts (SMEs), Quality Assurance colleagues, Transition teams, and operational staff to maintain consistent quality standards across all service delivery functions.

• Support operational readiness for new process implementations, system changes, policy updates, training programs, and quality framework enhancements.

• Participate in calibration sessions with quality teams to ensure audit scoring remains fair, objective, consistent, and aligned with approved quality standards.

• Collaborate with multiple departments to promote knowledge sharing, strengthen quality awareness, and support consistent service delivery across the organization.

• Contribute to a positive quality culture by encouraging accountability, continuous improvement, teamwork, and operational excellence.

Qualifications and Experience

Applicants should possess the following qualifications and experience:

• A minimum of three (3) to five (5) years of experience in an operations, quality assurance, quality auditing, or related operational role.

• Experience working within claims operations or healthcare-related processes will be an added advantage.

• Strong understanding of operational processes, quality assurance principles, compliance requirements, and audit methodologies.

• Practical experience using workflow management systems, quality assurance tools, Customer Relationship Management (CRM) systems, Microsoft Excel, and other operational software.

• Demonstrated ability to analyze operational data, identify trends, interpret audit findings, and recommend practical business improvements.

• Experience preparing quality reports, audit documentation, dashboards, and performance summaries.

Skills and Competencies

The successful candidate should demonstrate excellent attention to detail and consistently maintain high levels of accuracy while reviewing operational cases and quality records.

The candidate should possess strong analytical and critical thinking skills with the ability to identify patterns, determine root causes of quality issues, and recommend effective corrective actions.

Excellent written and verbal communication skills are essential for providing clear, balanced, and constructive audit feedback to employees, supervisors, and management.

The successful candidate should demonstrate effective time management skills with the ability to prioritize multiple audits, manage competing deadlines, and deliver quality work independently.

Strong problem-solving abilities are required to identify operational challenges, evaluate risks, and support process improvements that enhance operational efficiency.

The candidate should demonstrate a strong customer-focused approach by supporting quality improvements that contribute to positive customer experiences and high service standards.

A high level of integrity, fairness, professionalism, and objectivity is essential to ensure unbiased audit assessments and consistent application of quality standards.

The candidate should be able to work collaboratively with cross-functional teams while maintaining positive working relationships that support organizational goals and continuous improvement.

Fluency in English is required, while proficiency in additional languages will be considered an added advantage.

Key Competencies

• Quality Orientation with a strong focus on compliance, accuracy, consistency, and error-free operational performance.

• Analytical Thinking with the ability to interpret data, identify trends, and perform effective root-cause analysis.

• Attention to Detail when reviewing cases, documentation, customer interactions, and operational records.

• Collaboration skills that promote teamwork and productive relationships across departments.

• Effective Communication skills for delivering professional audit findings and constructive feedback.

• Strong Time Management skills to handle multiple audit assignments while meeting reporting deadlines.

• Process Discipline through consistent application of quality frameworks, governance standards, and Standard Operating Procedures.

• Continuous Improvement mindset focused on identifying opportunities to enhance operational performance and service quality.

• Objectivity and Fairness in applying quality standards and maintaining consistent audit scoring.

• Customer Focus by promoting operational excellence that protects customer experience and service quality.

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