Sr. Manager, Quality Audit

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Sr. Manager, Quality Audit based in the United States.

This is a senior operational leadership role focused on ensuring quality, compliance, and performance excellence across complex health plan administration and BPaaS operations. You will oversee audit strategy and execution across onshore and offshore teams, helping to strengthen process integrity, reduce operational risk, and improve service outcomes for health plan customers and their members. The role sits at the intersection of operations, compliance, and continuous improvement, requiring a leader who can translate data and audit findings into actionable business improvements. You will collaborate closely with cross-functional stakeholders across IT, configuration, contact center, and medical management teams. The position demands strong executive presence, as you will regularly report performance insights to senior leadership and client partners. This is a high-impact role designed for someone who thrives in complex, regulated healthcare environments and is motivated by operational excellence and scalability.

Accountabilities

This role is responsible for leading quality audit strategy, execution, and governance across healthcare operations to ensure compliance, efficiency, and continuous improvement.

Lead the design and execution of quality audit programs across BPaaS and health plan operational functions.
Oversee onshore and offshore audit teams to ensure consistency, accuracy, and adherence to defined standards and regulatory requirements.
Analyze operational processes and audit findings to identify risks, inefficiencies, and improvement opportunities.
Collaborate with cross-functional stakeholders including IT, configuration, contact center, and medical management teams to drive operational alignment.
Develop and maintain audit frameworks, policies, and procedures aligned with contractual, regulatory, and compliance obligations.
Prepare and present executive-level reports on audit outcomes, operational performance, and improvement initiatives.
Support the development and execution of strategies to improve KPIs, service quality, and operational efficiency.
Contribute to budget planning and resource optimization for audit and quality functions.
Drive continuous improvement initiatives, including process redesign, technology adoption, and automation opportunities.

Requirements

This position requires strong healthcare operations experience, audit expertise, and the ability to lead complex, multi-stakeholder environments.

Bachelor’s degree in Business, Healthcare Administration, or a related field.
8+ years of progressive leadership experience in health plan operations, claims, or related healthcare administration functions.
Strong understanding of claims processing, health plan operations, and regulatory compliance requirements.
Experience with Medicare Advantage operations preferred.
Proven ability to lead teams, manage performance, and oversee distributed (onshore/offshore) operations.
Strong analytical skills with the ability to interpret audit results and translate them into actionable improvements.
Excellent communication and executive presentation skills.
Demonstrated ability to work across multiple stakeholders and influence operational change.
Strong organizational skills with the ability to manage competing priorities in a complex environment.

Benefits

Competitive annual salary range of $155,000 – $165,000 USD, based on experience and qualifications.
Comprehensive medical, dental, and vision insurance coverage.
Remote work flexibility within the United States.
Paid time off and holiday programs.
Opportunities for professional growth in healthcare operations and quality leadership.
Exposure to large-scale health plan and BPaaS transformation initiatives.
Collaborative, cross-functional work environment with leadership visibility.
Inclusive workplace culture with a focus on innovation and continuous improvement.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

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Requirements

Benefits

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