Auditing, Coaching, Communication Skills, Detail Oriented, Health Plan, Healthcare, High School Diploma, Industry Standards, Leadership, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Operational Communications, Operations Planning, Organizational Skills, Performance Management, Performance Metrics, Problem Solving Skills, Quality Assurance, Quality Management, Regulatory Compliance, Time Management, Work From Home
Your Role
The Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Quality Assurance Auditors also provide coaching and work closely with business leaders to drive optimal results. The Quality Assurance Auditor, Specialist will report to the Quality Review Senior Manager. In this role you will develop performance metrics audit tools, evaluate performance, and provide coaching to ensure that staff have the skills and knowledge required to be successful in Appeals & Grievance (AGD).
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
- Requires a high school diploma or GED
- Requires at least 7 years of prior relevant experience
- Attention to details and the ability to communicate effectively
- Auditing experience preferred
- Experience in AGD preferred
- Knowledge of Health Plan operations, lines of business, general healthcare industry standards
- Strong organizational skills to conduct audits and reporting timely
- Hands-on experience using MS Office applications including Excel, Word, Outlook, PowerPoint preferred
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
Your Work
In this role, you will:
- Be responsible for performing audits that are routine in nature where limited judgment is required
- Focus on single area of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage
- Identify and document audit observations and findings
- Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging
- Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate
- Contributes to meeting and improving compliance performance
- Review audit data to identify care gaps, compliance risks, and trends
- Provide developmental coaching and support to all staff to improve the skills and competencies required to successfully perform work
Your Work
In this role, you will:
- Be responsible for performing audits that are routine in nature where limited judgment is required
- Focus on single area of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage
- Identify and document audit observations and findings
- Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging
- Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate
- Contributes to meeting and improving compliance performance
- Review audit data to identify care gaps, compliance risks, and trends
- Provide developmental coaching and support to all staff to improve the skills and competencies required to successfully perform work
B
Blue Cross and Blue Shield Association
At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.
2,000 to 2,499 employees
https://www.bcbs.com/about-us/careers