Operations Quality Analyst Jobs in Riverside, CA

SUMMARY

Responsible for serving as a subject matter expert for billing operations and quality by providing advanced operational support, analytical expertise, and process leadership across assigned programs. Partners with cross-functional teams to improve billing accuracy, strengthen operational controls, and enhance the customer experience through continuous improvement and system optimization. Supports the ongoing maturity of the organization's Billing Center of Excellence by driving operational consistency, quality standards, and best practices.

ESSENTIAL DUTIES AND RESPONSIBILITIES
Perform advanced billing reconciliation, including multi-system comparisons, GL validation, premium and refund analysis, payment application review, and discrepancy resolution.
Research and resolve recurring or systemic billing issues by partnering with Accounting, Operations, Information Technology, business partners, and vendors to identify root causes and implement corrective actions.
Serve as the subject matter expert (SME) for assigned billing systems by troubleshooting issues, documenting defects, gathering business requirements, validating enhancements, performing user acceptance testing, and serving as liaison with software vendors.
Recommend and implement process improvements that enhance billing accuracy, operational efficiency, automation, internal controls, scalability, and customer experience. Evaluate emerging technologies to improve billing operations.
Evaluate billing statements, invoices, premium and refund communications, payment notifications, and other customer-facing materials. Recommend enhancements that improve clarity, consistency, and customer understanding while reducing billing inquiries and maintaining compliance.
Develop and maintain reports, dashboards, KPIs, and performance metrics to monitor billing operations, quality, productivity, service levels, and operational risk. Analyze trends and provide recommendations to leadership.
Develop and maintain billing quality standards through audits, quality reviews, operational controls, and performance measures. Identify trends, recommend corrective actions, and monitor compliance with established standards.
Establish and maintain issue reporting, escalation, and resolution processes. Monitor recurring issues, perform root cause analysis, and communicate trends and recommendations to leadership.
Serve as the primary point of contact for escalated billing inquiries. Research complex issues and communicate professionally with brokers, insureds, clients, carriers, vendors, and internal business partners while remaining within non-licensed authority.
Manage shared inboxes and workflow queues; assign work to team members or offshore resources as appropriate; monitor service levels; communicate operational risks; and recommend workload improvements to support efficient service delivery.
Develop, maintain, and improve Standard Operating Procedures (SOPs), process documentation, workflow diagrams, job aids, and training materials to promote consistency, compliance, knowledge sharing, and continuous improvement.
Train, mentor, and support team members on billing systems, reconciliation processes, quality standards, customer communication best practices, and operational procedures. Assist with onboarding and serve as an operational resource.
Partner with leadership on strategic initiatives including system implementations, software enhancements, vendor management, automation, audits, process redesign, and other projects supporting the Billing Center of Excellence.
Performs all duties in accordance with all company policies and procedures, and all federal, state, and local laws wherein the Company operates. Performs other duties as assigned.

QUALIFICATIONS
EDUCATION / EXPERIENCE

Bachelor’s degree in Business Administration, Accounting, Finance, Insurance, or equivalent combination of education and experience

Four (4) or more years in Insurance operations, billing operations, accounting support, financial services, or related experience, including billing reconciliation, operational analysis, quality assurance, or process improvement.

License or Certification Property Casualty Insurance

SKILLS
Strong analytical, critical thinking, and problem-solving skills.
Advanced knowledge of billing operations, reconciliation principles, payment processing, refunds, and operational controls.
Ability to analyze and reconcile data across multiple systems with exceptional accuracy and attention to detail.
Knowledge of quality management principles, operational controls, audit practices, and continuous improvement methodologies.
Excellent verbal and written communication skills with the ability to explain complex billing concepts to technical and non-technical audiences.
Strong customer service and relationship management skills with internal and external business partners.
Ability to identify opportunities for process improvement and implement practical business solutions.
Experience developing reports, dashboards, KPIs, and operational metrics using Microsoft Excel and reporting tools.
Experience documenting business requirements, testing system enhancements, validating software changes, and collaborating with software vendors.
Ability to develop and maintain SOPs, process documentation, and training materials.
Demonstrated ability to train, mentor, and influence others without direct supervisory responsibility.
Strong organizational and project management skills with the ability to manage multiple priorities.
Advanced proficiency with Microsoft Office Suite, particularly Excel, Outlook, and Word; experience with billing, workflow, CRM, and financial systems preferred.
Ability to adapt to changing business needs while fostering operational excellence and continuous improvement.

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