Quality Assurance Specialist I

1 week ago

Owings Mills, United States CareFirst BlueCross BlueShield Full time

**Resp & Qualifications**

**PURPOSE**:
The Specialist, Quality Assurance I is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and company guidelines. Fairly and consistently reviews team interactions with both internal and external parties to ensure accuracy and support success in executing superior service and quality.

**ESSENTIAL FUNCTIONS**:
Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution.Assist with cross-training and skill development activities with less experienced staff in conjunction with management team,
Proactively identifies trends and training opportunities based on quality evaluations

**QUALIFICATIONS**:
**Education Level**: High School Diploma or GED.

**Experience**: 2 years progressive claims/customer service/enrollment &/or billing auditing experience, preferably in healthcare or insurance sector.

**Preferred Qualifications**: FACETS Claims

**Knowledge, Skills and Abilities (KSAs)**
- Basic knowledge of quality assurance and production technologies.
- Proficient in Microsoft Office programs.
- Basic knowledge of industry standards, quality control techniques and procedures.
- Excellent communication skills both written and verbal.
- Excellent Research and organizational skills.
- Excellent decision making and interpersonal skills.

**Salary Range**: $42,408 - $77,748

**Salary Range Disclaimer**

**Department**

FEHBP OPM HMO

**Equal Employment Opportunity**

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

**Where To Apply**

**Federal Disc/Physical Demand**

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

**PHYSICAL DEMANDS**:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

**Sponsorship in US**

Must be eligible to work in the U.S. without Sponsorship.

LI-TJ1

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