Performance Quality Auditor I

4 weeks ago


Wallingford, Connecticut, United States Elevance Health Full time

Job Summary:

The Performance Quality Auditor I is responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. This includes processes related to enrollment and billing, as well as customer service written and verbal inquiries.

Key Responsibilities:

  • 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.

Requirements:

Requires high school diploma or equivalent (GED); minimum 2 years experience with the company in an enrollment and billing, claims, and/or customer contact automated environment (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.

Preferred Skills:

Working knowledge of insurance industry and medical terminology and 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. Proficient in MS Office preferred. Prior experience processing claims strongly preferred. Experience with CAS and FlexCare systems preferred.

Benefits:

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements).

Work Environment:

Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

Equal Employment Opportunity:

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.



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