The Senior Quality Program Advisor will develop and manage reports to track KPIs, conduct root cause analysis, and provide strategic solutions aligned with the Quality Program business goals and strategy roadmap. This role will serve as the primary SME for business processes, advising leadership on best practices and industry trends. Additionally, the Senior Quality Program Advisor will manage projects, deliver strategic plans, and communicate complex findings to stakeholders, ensuring continuous alignment with operational objectives and enhancing function efficiency.
This role will primarily function in the Grievance & Appeals (G&A) department and serves as a subject matter expert (SME) for G&A operations, acting as a key liaison between departments to ensure regulatory compliance and optimize performance. The G&A Senior Quality Program Advisor supports leadership by analyzing inventory data, identifying trends, and providing actionable insights to improve turnaround times. Additionally, the advisor plays a critical role in developing reports and presentations that drive strategic decision-making and enhance operational efficiency.
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Responsibilities:
- Develop and manage operational reports to track key performance indicators (KPIs), ensuring accurate insights into business data.
- Conduct data-driven root cause analysis to identify strategic solutions that align with business goals.
- Serve as the primary SME for operational processes, advising leadership on best practices, trends, and potential risks.
- Stay current on emerging developments and trends within the industry to recommend proactive adjustments to processes.
- Provide recommendations to management on operational adjustments to enhance efficiency and outcomes.
- Participate in the planning, coordination, and execution of operational initiatives related to assigned business portfolio and the Quality program holistically. Manage timelines, deliverables, and communication to ensure the successful completion of projects.
- Provide high-level guidance and strategic recommendations, ensuring that business needs are met and aligned with organizational goals.
- Deliver strategic plans, high-level requirement documents, and executive presentations that outline the proposed solutions and their alignment with business capabilities.
- Communicate complex findings in a clear, concise manner to non-technical stakeholders.
- Monitor the effectiveness of implemented changes, ensuring continuous alignment with operational objectives and stakeholder expectations.
- Serve as a G&A SME and a liaison to other departments within the enterprise; specifically with a focus on a deep understanding of regulatory requirements, G&A operational practices and Key Performance Indicators.
- Partner with G&A leadership to support departmental initiatives; creating detailed reports and presentations with actionable recommendations.
- Conduct analyses within G&A's inventory to assist leadership with ensuring turnaround times are met and mitigating avoidable misses.
- Continuously monitor G&A data to determine what is driving inventory; partner with G&A leadership to suggest ways to drive down inventory.
- This list is not all-inclusive and you are expected to perform other duties as requested or assigned.
Qualifications:
- 4+ w/Bachelor's degree
- Experience in collecting and compiling data, identifying basic trends, and preparing initial drafts of reports. Experience in gathering and reporting on customer feedback.
- Understanding of quality assurance processes and standards.
- Proficiency in analyzing data to identify trends, root causes, and strategic solutions.
- Awareness of emerging developments and trends within the industry.
- Knowledge of and ability to execute project planning, coordination, and execution best practices.
- Ability to conduct data-driven root cause analysis and develop insights.
- Expertise in developing and managing operational reports to track KPIs.
- Strong ability to communicate complex findings clearly to non-technical stakeholders.
- Excellent verbal, written and interpersonal communication skills.
- Capability to serve as a subject matter expert and advise leadership on best practices and potential risks.
- Ability to identify and recommend operational adjustments to enhance efficiency and outcomes.
- Ability to monitor the effectiveness of implemented changes and ensure alignment with operational objectives.
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 19. $63,700 - $133,500
Additional Information:
Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes:
- Competitive base and incentive pay
- 401(k) with robust matching and non-matching contributions
- Rich medical & pharmacy benefits
- 100% employer-paid dental and vision benefits
- Holistic wellbeing program with deep financial incentives
- Generous paid time off plus 12 paid holidays and your birthday off
- Culture of growth and learning: career development; tuition reimbursement; recognition program
- Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
- Social responsibility and volunteer opportunities
- Employee discount program
Fair Chance Ordinances and Criminal Background Considerations
This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A.
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