Position SummaryThe Quality Review and Audit Senior Supervisor is responsible for leading quality assurance, audit support, operational oversight, and customer escalation functions supporting the Individual Dental business. This role ensures operational processes, customer interactions, vendor activities, and business practices are executed in accordance with established procedures, regulatory requirements, and quality standards while delivering effective resolution of complex customer concerns and business issues.
The Quality Review and Audit Senior Supervisor leads a team responsible for quality monitoring, audit activities, customer issue intake, complaint management, regulatory inquiries, and escalation resolution. This leader partners closely with Operations, Compliance, Vendor Management, Customer Operations, Enterprise teams, and business stakeholders to identify operational risks, improve customer outcomes, strengthen controls, and support continuous improvement initiatives across the Individual Dental organization.
Core Accountabilities and Responsibilities Quality Assurance & Operational Oversight- Lead quality assurance activities supporting operational excellence across the Individual Dental business.
- Establish and maintain quality monitoring programs, audit methodologies, evaluation standards, and reporting processes.
- Review operational performance, customer interactions, vendor activities, and business processes to assess adherence to established standards and requirements.
- Analyze quality trends and identify opportunities to improve operational effectiveness, customer outcomes, and business performance.
- Partner with operational leaders to implement corrective actions, process improvements, and performance enhancement initiatives.
Customer Escalations & Complaint Resolution- Lead a team responsible for intake, triage, tracking, investigation, and resolution of customer concerns received through multiple channels.
- Oversee management of Department of Insurance inquiries, executive escalations, Exchange-related requests, Access to Care concerns, complaints, grievances, and other complex customer issues.
- Ensure customer concerns are documented, prioritized, investigated, resolved, and communicated appropriately.
- Provide leadership support on highly sensitive, complex, or high-visibility customer matters.
- Drive root cause identification and partner with business stakeholders to prevent recurring customer issues.
Audit Support & Compliance Monitoring- Support internal, external, enterprise, and regulatory audit activities impacting the Individual Dental business.
- Coordinate collection, validation, and organization of audit evidence, supporting documentation, and business responses.
- Assist in development and maintenance of audit programs, monitoring activities, and corrective action tracking.
- Identify control gaps, operational risks, and process deficiencies through quality reviews, audits, and escalation trends.
- Partner with business stakeholders to ensure remediation activities are completed and documented appropriately.
Regulatory & Exchange Oversight- Monitor activities affecting compliance with applicable Federal Exchange, State-Based Exchange, Department of Insurance, and business requirements.
- Ensure customer inquiries and issue resolution activities meet established turnaround expectations and business standards.
- Support implementation of operational requirements resulting from regulatory or business changes.
- Partner with Compliance and operational teams to address identified compliance concerns or operational risks.
- Monitor trends and emerging issues that may impact regulatory performance or customer experience.
Data Analysis & Continuous Improvement- Analyze operational data, audit findings, customer complaints, quality review results, and business metrics to identify trends and opportunities.
- Conduct root cause analyses to determine drivers of quality issues, customer concerns, operational deficiencies, and audit findings.
- Recommend process improvements that enhance quality, compliance, operational performance, and customer satisfaction.
- Lead or support projects focused on operational improvement, quality enhancement, and customer experience optimization.
- Communicate findings and recommendations to leadership and business stakeholders.
Cross-Functional Partnership & Stakeholder Management- Partner with Operations, Customer Service, Compliance, Risk Management, Vendor partners, Enterprise teams, and business leaders to address operational and customer issues.
- Facilitate collaboration across teams to support issue resolution, corrective actions, and operational improvements.
- Present findings, recommendations, and performance results to management and business stakeholders.
- Support organizational initiatives that improve quality, operational effectiveness, and customer experience.
- Serve as a subject matter expert regarding quality assurance, escalation management, and audit-related activities.
Leadership & Team Development- Lead, coach, mentor, and develop a team responsible for quality reviews, audit activities, customer escalations, and complaint resolution.
- Establish performance expectations, goals, and accountability measures that support operational effectiveness and customer satisfaction.
- Coordinate workload distribution, staffing priorities, and operational execution across the team.
- Support employee development, onboarding, training, performance management, and recognition activities.
- Foster a culture of collaboration, accountability, customer focus, and continuous improvement.
Qualifications- Bachelor's Degree or equivalent business experience required.
- 5+ years of experience in healthcare, insurance operations, quality assurance, audit, compliance, customer service, claims, enrollment, or related business functions.
- 2+ years of leadership or supervisory experience preferred.
- Strong understanding of Individual and Family Plan operations, dental products, customer servicing, and operational workflows.
- Experience supporting quality assurance, audit activities, complaints, grievances, escalations, or regulatory inquiries.
- Knowledge of Federal Exchange, State-Based Exchange, Department of Insurance, or other regulatory environments preferred.
- Strong analytical skills with demonstrated ability to identify trends, conduct root cause analyses, and develop actionable recommendations.
- Excellent verbal and written communication skills.
- Strong organizational, prioritization, and stakeholder management capabilities.
- Ability to function effectively in complex, fast-paced, and highly regulated environments.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
