Senior Manager – Quality Audit Operations
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior Manager leading AI-enabled healthcare quality audit programs at Cotiviti. Governing accuracy, remediation, productivity, and continuous improvement across human and AI-supported reviews.
Responsibilities:
- Lead a team responsible for developing, executing, and continuously improving CCV quality assurance programs across multiple review types
- Own and mature the quality program framework, including quality controls, sampling strategy, escalation routines, governance cadence, and sustained monitoring
- Define, measure, and monitor accuracy, consistency, and decision quality across AI-supported and human-reviewed workflows
- Identify early quality signals, accuracy drift, and client-facing or operational exposure using root cause analysis, trend monitoring, and risk segmentation
- Partner with operations, analytics, technology, training, and client-facing leaders to translate quality findings into action
- Develop remediation plans with containment, ownership, timelines, measurable success criteria, governance checkpoints, and evidence of sustained improvement
- Ensure AI-supported workflow changes use controlled pilots, release-readiness criteria, risk-based testing, documentation, post-implementation monitoring, and stakeholder alignment
- Champion responsible AI innovation to improve audit performance, review effectiveness, quality insights, accuracy, productivity, risk detection, and client value
- Drive continuous improvement through accountability, disciplined execution, data-driven coaching, feedback loops, reinforcement, and outcome monitoring
- Communicate emerging risks and remediation progress to senior leadership
- Maintain relationships across the quality organization and audit enterprise; identify and communicate opportunities that create client value
- Establish reporting and insights on quality program performance and business patterns using meaningful metrics
- Ensure QA productivity goals and standards are met or exceeded; monitor coverage and redistribute work as needed
- Remove productivity roadblocks and resolve performance issues
- Lead, motivate, hire, develop, coach, and retain talent
- Operationalize new quality programs and initiatives with internal stakeholders, including CCV Operations, Validiti, content teams, and Client Service
- Coordinate execution, monitoring, and maintenance of quality standards with client service teams
- Work with teams developing clinical, coding, and quality-related content
- Oversee concept development and maintenance of quality criteria within program tools
- Manage external stakeholder expectations, project scope, schedules, resources, operational cycles, and delivery impacts
- Complete performance-review responsibilities, special projects, and assigned duties
Requirements:
- Bachelor's degree in a related field required
- 3+ years of technical leadership experience with people and projects
- AI-native experience using generative AI applications such as Claude, Microsoft Copilot, or similar tools
- Understanding of AI validation, exception review, quality drift, and human-in-the-loop controls
- Ability to translate AI quality concepts into measurable accuracy improvement
- Experience influencing behavior and driving adoption of process, quality, or performance improvements across audit teams
- Experience building remediation plans with owners, milestones, measurable success criteria, and follow-through
- Ability to communicate complex quality and risk concerns concisely to senior leadership
- Advanced Excel knowledge, including Pivot Tables, macros, VLOOKUPs, queries, and advanced formulas
- Strong analytical and problem-solving ability
- Organizational skills and attention to detail and accuracy
- Ability and capacity to learn new concepts and software
- Excellent written and verbal communication skills
- Experience in a HIPAA-regulated environment
- Comfortable speaking before groups, with clients, and with physician executives
- Professional handling of confidential information
- Ability to work independently and in a team environment
- Ability to handle multiple tasks, prioritize, and meet deadlines
- Ability to mentor staff and enhance performance
- Skilled in root cause analysis, trend monitoring, and risk segmentation
- Must be able to provide a dedicated, secure work area
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance
- Experience with quality management methodologies such as Six Sigma, Lean, or CAPA is a plus
- Experience developing or maintaining quality assurance programs, audit methodologies, or quality monitoring systems is a plus
- Knowledge of medical reimbursement/payment policies, audit review methodologies, and medical terminology is a plus
- Must be able to perform duties with or without reasonable accommodation
Benefits:
- Discretionary bonus consideration
- Medical insurance coverage
- Dental insurance coverage
- Vision insurance coverage
- Disability insurance coverage
- Life insurance coverage
- 401(k) savings plans
- Paid family leave
- 9 paid holidays per year
- 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service
- Remote work arrangement
- Dedicated secure work area and high-speed internet/home office setup supported as working requirements
Similar Jobs
Partner Services Operations Specialist
Partner Services Operations Specialist supporting ancillary insurance operations at USAble Life. Researching service issues, maintaining benefit data, and coordinating cross-functional resolutions remotely.
Senior Operations Manager, Optimization
Senior Operations Manager improving data, processes, and systems for the National Wildlife Federation. Supporting conservation programs through operational analysis, cross-functional leadership, and strategic recommendations.
Operations Manager – Law Firm Operations Administrator
Operations Manager supporting the COO of a U.S. immigration law firm. Improving workflows, automation, reporting, CRM systems, and staff operations across a fully remote Asia-based team.
Health Plan Data Operations Associate Internship
Health plan data operations intern supporting GDIT’s WTC Health Program provider data. Verifying data, updating provider rosters, and coordinating healthcare operations initiatives.
Head of Operations Finance
Head of Operations Finance overseeing cost accounting, inventory valuation, budgeting, and operational reporting. Supporting Canopy Growth’s cannabis and hemp business through finance leadership and process improvement.
Manager, Insurance Operations
Insurance Operations Manager leading service reporting, escalations, process improvements, and advisor relationships. Managing a small team for Mariner Wealth Advisors, a wealth management firm.
Operations Lead Analyst
Operations Lead Analyst managing healthcare accumulator relationships for Evernorth Health Services. Resolving vendor issues, analyzing trends, and recommending process and technology improvements remotely from Tennessee.
Accounts and Operations Manager
Accounts and Operations Manager leading Cleankill and Clearup pest control operations across London and the South East. Managing field teams, service delivery, compliance and major commercial client relationships.
Fueling Operations Support Manager
Fueling Operations Support Manager maintaining Ryder’s transportation and supply-chain fueling facilities nationwide. Troubleshooting systems, managing compliance, repairs, customer support, projects, and performance reporting.
Team Lead, IT Operations & Service Management
Team Lead für interne IT-Operations und Service Management beim digitalen Immobilienverwalter Reos. Sicherstellung der Microsoft-Arbeitsumgebung, IT-Projekte, Support-Prozesse und Dienstleistersteuerung.
Especialista em Observabilidade e AIOps
Especialista em Observabilidade e AIOps evoluindo monitoramento, automação e integrações ITSM na UltraCon, consultoria de TI. Melhorando correlação de eventos, dashboards, cobertura de monitoração e dados para agentes de IA.
Growth Operations Manager – Dealership
Growth Operations Manager supporting Vehlo’s dealership software customers and revenue teams. Managing enablement, CRM tools, campaigns, process improvements, and GTM analytics.
Platform Operations Specialist
Platform Operations Specialist configuring uMed’s clinical research technology platform. Supporting studies, releases, documentation, compliance, and operational process improvement.
Commercial Real Estate Operations Admin
Remote Operations Admin supporting a Southern California commercial real estate advisory group. Managing CRM pipelines, property research, marketing, and transactions from listing through closing.
Commercial Real Estate Operations Admin
Remote Operations Admin supporting a Southern California commercial real estate advisory group. Managing CRM, property research, marketing, and transactions from listing through closing.
Customer Operations Associate
Customer Operations Associate supporting Mercuryo’s crypto and Web3 financial-services users overnight. Handling customer issues across chat, email, and social media while escalating technical incidents.
Director of Apparel Operations – Systems
Breezy Golf operations director owning ERP/EDI systems, fulfillment, freight, inventory, and 3PL networks for a fast-growing apparel brand. Leading wholesale compliance and operations teams.
Training Operations Lead
Training Operations Lead scaling crane and rigging instructor-led programs for Interplay Learning, an immersive skilled-trades training company. Managing scheduling, logistics, systems, data, contractors, and course closeouts.
Operations and Logistics Administrator
Operations and Logistics Admin supporting U.S. Nursing’s healthcare strike staffing services. Managing procedures, housing logistics, client communications, systems, tickets, and surveys.
Litigation Operations Consultant, Projects & Technology
Litigation operations consultant managing legal project portfolios, technology, and process improvement initiatives. Supporting AAA insurer attorneys and cross-functional business partners across the United States.