QC & Verification of Benefits Lead - Remote

Davita Inc.; Morrisville (NC); Remote; USD 90,000 - 100,000; Full time

Job summary

A leading company seeks a full-time Verification of Benefits/Quality Control Lead to oversee teams ensuring compliance with federal regulations and quality standards. The role involves developing procedures, auditing documentation, and collaborating with stakeholders while working remotely within the United States. Candidates should possess relevant degrees and analytical skills, with a competitive salary offered based on experience.

Benefits

10 paid Holidays

Vacation Pay

Sick Pay

401 (K) plan with matching

Company paid STD and LTD

Qualifications

• Two years of experience in high-level review of documentation.
• Ability to perform in a fast-paced environment with limited supervision.
• Knowledge of compliance and regulatory requirements.

Responsibilities

• Lead VOB and QC teams to ensure compliance and accuracy.
• Conduct regular audits and compliance checks.
• Develop and maintain standard operating procedures.

Skills

Analytical skills

Organizational skills

Communication skills

Education

Associate or Bachelor's degree

Tools

Microsoft Office Suite

SmartSheet

Power BI

Adobe Reader

SharePoint

Job description

QC & Verification of Benefits Lead - Remote

IEM is looking for a Full Time- Verification of Benefits/Quality Control Lead who will oversee VOB and QC teams, ensuring compliance with applicable federal regulations, program policies, and quality standards. The VOB/QC Lead will develop and maintain VOB and QC standard operating procedures and training materials and will assure that established policies and processes are followed. This position will engage with other project managers and key stakeholders and serve as liaison for inquires or concerns pertaining to benefit verification and QC practices.

Primary Location:

• Live anywhere that meets remote work requirements in the United States including Puerto Rico.
• Work remotely from home or personal office location.

Essential Functions:

• Lead VOB and QC teams to review applicant records for duplication of benefits (DOB), fraud, waste, and inconsistencies to verify accuracy and ensure compliance.
• Investigate and collaborate with internal and external partners to log and resolve compliance issues and communicate and escalate cases to management according to defined standard operating procedures.
• Conduct regular audits and compliance checks on processed documentation and implement training or process enhancements based on audit outcomes and data analysis.
• Analyze and verify the accuracy and completeness of applicant information.
• Maintain comprehensive knowledge of program regulations, policy, departmental process flows, standard operating procedures, and compliance requirements.
• Ensure consistency and objectivity in all record reviews and assessments.
• Develop detailed QC reporting and/or dashboards to communicate team outcomes and productivity.
• Lead the development and continuous improvement of VOB and QC policies and processes.
• Manage individual workloads, productivity, and communications that enable accurate, efficient, and policy compliant processing.
• Contribute to team success with effective training, communication and sound decision making.
• Provide timely and accurate responses to VOB/QC-related inquiries.
• Monitor trends in VOB/QC reviews to identify systemic issues and address them proactively.

Minimum Qualifications:

• Degree: Associate or Bachelor's degree from an accredited university in a relevant field.
• Experience: Two (2) years of experience providing high level review of documentation and strong analytical skills.
• Experience and Degree Substitution: An equivalent combination of education, experience, and training that demonstrates the required knowledge, skills, and abilities necessary to effectively perform the duties and functions of this position may be considered.
• Ability to exercise impartial, unbiased professional care when reviewing case files., including using the highest level of professional objectivity for gathering, evaluating, and communicating information.
• Analytical and comprehension skills to review and understand The Stafford Act and Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Award, 2 C.F.R. Part 200, especially Subpart F - Audit Requirements of the Uniform Guidance, implementing the Single Audit Act.
• Ability to perform tasks within a fast-paced environment and limited supervision.
• Demonstrate strong organizational and administrative competencies inclusive of exceptional record keeping, scheduling and task tracking abilities, excellent communication skills and commitment to teamwork and excellence.

Preferred Qualifications:

• Knowledge of federally funded grant programs such as CDBG/CDBG-DR, FEMA HMGP, Treasury ARPA, and CARES Act grants.
• Knowledge of various database and program management tools such as SmartSheet, Power BI, Adobe Reader, SharePoint and other Microsoft Office Suite products
• Experience with housing program policy, documentation, and processes.
• Understanding of the importance and correct handling of personally identifiable information (PII).

Additional Information:

• Remote Locations: All remote work environments require the ability to maintain minimum Internet speeds of 25 Mbps upload and 3 Mbps download, as well as a ping rate of 100 ms or less during working hours, regardless of the type and number of devices using your Internet connection. You must also have account privileges and access to your Internet service provider account during working hours for the purposes of maintaining the Internet connection, if needed.

Benefits and more:

• Annual salary based on experience and location $90,000-$100,000
• 10 paid Holidays
• Vacation Pay
• Sick Pay
• 401 (K) plan with matching
• Company paid STD and LTD

Equal Employment Opportunity: All IEM employment decisions, including recruiting, hiring, placement, training availability, promotion, compensation, evaluation, disciplinary actions, and termination of employment, if necessary, are made without regard to an individual's race, color, religion, creed, sex (including sexual orientation, gender identity, and gender expression), national origin, ancestry, age, physical or mental disability, medical condition, genetic information, pregnancy (including childbirth and related medical conditions), marital status, military or veteran status, citizenship or immigration status, or any other characteristic protected under applicable law.

Reasonable Accommodation: IEM is committed to providing reasonable workplace accommodations for individuals with disabilities. If you require assistance or reasonable accommodation during any part of the application or employment process, please email [e-mail] with specific details about the requested accommodation. All accommodation requests are reviewed case-by-case in compliance with applicable law.