Quality Assurance Auditor, Advanced

1 week ago

Lodi, United States Blue Shield of California Full time

**Your Role**

The Quality Assurance Team conducts audits, documents quality issues and performance measures and conducts review of policies and procedures to ensure alignment with service level requirements. The Quality Assurance Auditor, Advanced will report to the Quality Assurance Manager. In this role they will conduct quality reviews on multiple lines of business and identify and document audit observations and findings.

**Your Work**

**In this role, you will**:

- Be responsible for performing audits that are routine in nature where limited judgment is required
- Focus on multiple areas 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
- Manage timelines, assignments, and work plans.

**QUALIFICATIONS
Your Knowledge and Experience**
- Requires a high school diploma or GED
- Requires at least 5 years of prior relevant experience
- Requires processing/auditing knowledge of Installation and Billing lines of business including multiple of the following: Large Group Member Maintenance, Small Group Member Maintenance, Mei-Cal, IFP Install & Maintenance, Billing, Large Group Install, Small Group Install.
- Excellent written and verbal communication
- Ability to document findings and communicate with Leaders Excellent Time Management

**Pay Range**:
The pay range for this role is: $20.82 to $29.15 per hour for California.

**Note**:
ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us

**Our Values**:

- **Honest **. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- **Human **. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- **Courageous **. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

**Our Workplace Model**:
Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office
- Hybrid - In a business unit approved office a few times per year to 3 days per week, on average

**Physical Requirements**:
Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

**Equal Employment Opportunity**:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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