Performance Quality Auditor II
Performance Quality Auditor II
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Job Description
Anticipated End Date:
Position Title:
Performance Quality Auditor IIJob Description:
Performance Quality Auditor II
Virtual:This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. This approach promotes productivity supports work-life integration and ensures essential face-to-face onboarding and skill development.
The PERFORMANCE QUALITY AUDITOR II is 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 the 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.
Minimum Requirements:
- Requires high school diploma or equivalent (GED); a minimum of 3 years experience including a minimum of 1 year related experience in quality audit capacity (preferably in the healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
Preferred Skills Capabilities and Experiences:
- Strong verbal and written communication skills.
- Ability to effectively provide receive and apply constructive feedback.
- Strong time management skills to handle assigned workload.
- Proficiency with Microsoft Word Excel Teams and Outlook experience.
- Understanding of audit methodologies.
- Claims processing experience.
- Coordination of Benefits experience required which includes detailed working knowledge of NAIC guidelines CMS primacy rules and claim coordination methodology.
- Proficiency with portal tools used for COB Verification.
- Strong WGS experience.
- Claims processing experience.
- Medicare Secondary Payer experience
- Basic working knowledge of COB prevention data match claims edits and inquiries team processes strongly preferred.
Job Level:
Non-Management Non-ExemptWorkshift:
1st Shift (United States of America)Job Family:
QLT > AuditPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.
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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager 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.
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 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.
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 for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Employment Type
Full-Time
