Performance Quality Auditor II
Company: Elevance Health
Posted on: May 29, 2023
Performance Quality Auditor II
Job Family: Customer Care
Type: Full time
Date Posted:May 10, 2023
Req #: JR70653
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Title: Performance Quality Auditor II
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Performance Quality Auditor II will be responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.
How you will make an impact:
Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
Tracks and trends audit results, providing feedback to management.
Identifies and reports on systemic issues which create ongoing quality concerns.
Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
Produces other ad hoc reports as requested by internal and external clients.
Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.
High school diploma or equivalent (GED);
Minimum of 3 years experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
Working knowledge of insurance industry and medical terminology and detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred.
Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred.
Life & Disability experience preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $19.46/hr. to $38.90/hr.
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to
have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World's Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.
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Performance Quality Auditor II
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