Enrollment Quality Assurance Analyst

Network Health WI

. Monitor and evaluate operational data to identify quality gaps, ensure compliance, and improve enrollment processes and service .

Posted 10/26/2026full-timeMenasha • Wisconsin • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in auditing processes, regulatory compliance, and continuous improvement within healthcare operations. Proficient in analyzing operational data to identify quality gaps and recommend corrective actions.

Highest-signal resume keywords

Auditing ExperienceRegulatory Compliance KnowledgeHealthcare Industry ExperienceData Analysis SkillsProcess Improvement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Internal AuditsRoot Cause AnalysisCorrective Action PlansEnrollment Data ValidationQuality AssuranceOperational EfficiencyTrend AnalysisReportingModel Audit RequirementsService Level Agreements

Soft Skills

CommunicationCollaborationProblem-SolvingAttention to DetailTraining Coordination

Industry Keywords

CMSOCIHEDIS AuditsEnrollment ProcessesState and Federal Regulatory Standards

About the role

Key responsibilities & impact

Monitor and evaluate operational data to identify quality gaps, ensure compliance, and improve enrollment processes and service
Conduct internal audits supporting Model Audit Requirements (MAR) and Service Level Agreements
Partner with Internal Audit as needed
Resolve complex issues and support primary department functions
Maintain department desk-level procedures
Monitor enrollment transactions to identify trends and root causes
Recommend corrective actions and support continuous process improvement
Review department policies and procedures for regulatory compliance, operational efficiency, and industry best practices
Collaborate with enrollment, quality assurance, compliance, regulatory, and software vendor stakeholders
Track and trend audit results to identify improvement opportunities
Serve as a subject matter expert for CMS, OCI, MAR controls, HEDIS audits, and Enrollment Data Validation (EDV) monitoring activities
Provide accurate and timely reporting
Communicate process issues, resource needs, and training opportunities to department leadership
Perform audits and support root cause analysis and corrective action plans
Assist in monitoring department phone lines and email inboxes and coordinating staff coverage
Perform other duties as assigned

Requirements

What you’ll need

High school diploma or equivalent
2 or more years working in an auditing focused role required
2 or more years of experience in health care required
Must reside in the state of Wisconsin
Reliable internet required for home-office work
Knowledge of current state, federal, and industry regulatory standards and service expectations

Benefits

Comp & perks

Eligible to work at a home office with reliable internet
Hybrid workplace model available
Paid time to volunteer in the local neighborhood