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Performance Quality Auditor I

1 month ago

Miami, Florida, 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.
  • Produces other ad hoc reports as requested by internal and/or external clients.

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.

Salary and Benefits:

The salary range for this position is $42,435 to $63,642 or $20.40 to $30.60 hourly. Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).