Operations Quality Assurance Analyst

Delta-Denta; Greenwood Village (CO); Hybrid; USD 34,000 - 46,000; Full time

Benefits offered by this job

PTO 23 days

11 paid holidays

6 paid illness days

Medical health plans

Dental insurance

Vision and hearing plan

401(k) match

Retirement savings plan

Life insurance

Short-term disability

Long-term disability

Wellness program

ECO Passes

Job summary

Delta Dental of Colorado is seeking an Operations Quality Assurance Analyst to ensure workflows, systems, policies, and procedures meet DDCO standards and industry regulations. This role involves reviewing, testing, and analyzing various aspects of Delta Dental of Colorado, including claims processing, customer experience, provider relations, and Clinical Management.

The Analyst identifies opportunities to mitigate risk and drive service excellence within Operations.

Qualifications

• Strong QA knowledge for a health insurance company.
• Experience with data extraction and quality control is preferred.
• Familiarity with DDCO workflows and policies is a plus.

Responsibilities

• Conduct and prepare detailed QA audits focused on workflows and internal processes.
• Create and distribute Quality Assurance reports on a regular basis.
• Maintain and update QA policies and procedures.
• Collaborate with other departments to identify and resolve issues within Payor systems.

Skills

Quality assurance

Data analysis

Salesforce

Tableau

Power BI

Healthcare knowledge

Communication

MS Office

Education

High school diploma or equivalent

Tools

Salesforce

Job description

The Operations Quality Assurance Analyst ensures that Operations workflows, systems, policies, and procedures meet company standards, DDPA requirements, and industry regulations. This role involves reviewing, testing, and analyzing various aspects of Delta Dental of Colorado, including claims processing, customer experience, provider relations, and Clinical Management. The Analystroleidentifiesareas of opportunity and service excellence within the Operations departments to mitigate or maximize risk related to financial liability, membership retention, and acquisition. This position is crucial in ensuring that Operations practices conform to both internal and external industry standards.

Position Requirements:

Education, Licensure,and Experience:

• High school diploma or equivalent isrequired.
• Previousexperience in data analysis, including input, maintenance, qualitycontroland extraction of data is strongly preferred.
• One year of experience in a DDCO Operations department is strongly preferred.

Skills and Abilities:

• Strong written and verbal communication skills with the ability to effectively communicate with all levels of staff.
• Strong quality assurance knowledge for a health insurance company (dental or medical preferred).
• Strong working knowledge of current DDCO Operations workflows,systems and policiesand procedures including but not limited to Claim Processing, Customer Experience,Clinicalstronglypreferred.
• Exceptional multitasking, critical thinking, attention todetailand analytical skills arerequired.
• Working knowledge in Salesforce and experience with databasesystemsuch as tableau or Power BI is strongly preferred.
• Working knowledge of dental insurance industry terminology and services preferred.
• Ability to gather,analyze,and synthesize information and data from multiple sources.
• Excellent organizationalandtime managementskillswith the ability tohandle multiplepriorities andprioritize and schedule accordingly.
• High levelof integrity and discretion in handling confidential information.
• Excellent interpersonal and communication skills.
• Strong problem-solving skills and the ability to adapt to changing priorities.
• Ability to work independently and collaboratively in a team environment.
• Intermediate knowledge of the most recent version of Microsoft Office suiteusingOutlook,Word,Excel,PowerPoint,andTeams.

Essential Functions

• Conduct and prepare detailed QA audits focused on workflows and internal processes at the departmental level and F inancial Accuracy auditsreported outquarterly for Performance gua rantees and DDPA exam . Present audit findings and actionable recommendations for improvement to DDCO leadership, ensuring alignment with company standards and industry regulations.
• Create and distribute comprehensive Quality Assurance Reports on a monthly, quarterly, annual (including fiscal year), and ad hoc basis. Summarize individual and departmental audit results and present them to management regularly. Collaborate with the Audit, Risk, and Compliance Services team for client-specific audit requests.
• Maintain a thorough understanding of Operations departments and workflows to inform quality assurance best practices. Continuously update knowledge to stay current with changes and improvements in operational processes.
• Work closely with other departments toidentifyand resolve benefit, product, and provider workflow issues within the Payor system.Communicate effectively with team members to ensure timely resolution and continuous improvement.
• Maintain and enhance existing audit processes, and develop new ones as needed to improve service levels and performance guarantees. Ensure audit processes are robust, efficient, and aligned with organizational goals.
• Collaborate with Learning and Development and HR to develop feedback loops for training and hiring new team members. Provide recommendations for training programs, new policies, and system changes to enhance team performance and operational quality.
• Plan, coordinate, and execute in-depth organizational processor audits and side-by-side evaluations to ensure adherence to quality standards andidentifyareas for improvement.
• Review and update quality assurance policies and procedures. Interpret and implement quality assurancestandards andevaluate their adequacy in partnership with the Operations Program Manager.
• Prepare detailed QA audit findings at the departmental level and make recommendations for improvement to DDCO leadership. Ensure findings are well-documented and actionable.
• Routinely audit other QA team members through the auditor program to ensure quality within the Quality Assurance Team. Provide feedback and support tomaintainhigh standardsof qualityassurance across the team.

General Position Responsibilities:

• Support teams in making data-driven decisions by providingtimelyandaccuratedata insights.
• Keep up to date with the latest technology and data analysis trends to improve organizational performance, including incorporating tools like CoPilot.
• Suggest and proactively implement new methods for data analysis and interpretation, driving continuous improvement and innovation.
• Become familiar with and followDDCO-wideanddepartment-specificpolicies,standard operatingproceduresand the DDCO Core Values; seekassistance from management when clarification or assistance is needed.
• Assistothers as requested.

Degree of Authority/Management:

Team membersin this position will be expected to perform most job duties and responsibilities independently andin accordance withestablished departmental andorganizational policies andstandard operatingprocedures.

This positionis notresponsible for the supervisionofany other positions at DDCO.

Working Conditions:

• This joboperatesin a professional office environment. This role routinely uses standard office equipment such as computers, phones, and photocopiers.Regular exposure to a computer screen.
• No physical effort beyond that is typicallyrequiredin a normal office environment.
• This position is a hybridrolethat requiresonedayin the officeperweek,howevermay changebased upon the needs ofthe organization.
• Ability to perform the essential functions of the job with or without reasonable accommodation.

Delta Dental of Colorado offers a comprehensive compensation and benefits package. Some of the highlights from our benefits package include:

• 23 days of PTO
• 11 paid holidays
• 6 paid illness days
• Three affordable medical health plans
• Fantastic dental insurance plan
• Vision and hearing plan
• 401(k) match with immediate vesting
• Supplemental retirement savings plan
• Company-paid life insurance, short-term disability, and long-term disability policies
• Wellness program
• ECO Passes for team members (we are near a light rail station!)

Compensation: This non-exempt position has an hourly pay range of $25.04 to $33.06. This position is also eligible for a monthly internet allowance.

Posting Close Date: 9/14/26

This is a hybrid position that requires working on-site in our Centennial office one day per week. This schedule may change based on business needs.

Delta Dental of Colorado is proud to be an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity, genetic information, military or veteran status, national origin, race, religion, sex, sexual orientation, or any other applicable status protected by federal,state,or local law.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.