Job DescriptionYour RoleThe Internal Audit team is responsible for performing compliance and contractual audits such as Licensee Desk Level Audit, Local Operations Scorecard, and Federal Employee Program. The Quality Assurance Auditor, Specialist will report to the Internal Audit Senior Manager. In this role you will be ensuring adherence to established specifications, quality standards, contractual agreements, and Blue Cross Blue Shield Association guidelines and conduct comprehensive quality reviews to identify performance deficiencies.
ResponsibilitiesYour WorkIn this role, you will:
- Be responsible for performing transactional quality review audits with minimal supervision
- Audit multiple areas, including Claims, Customer Service, Enrollments, etc.
- Objectively review and interpret standards, procedural documentation and contract and legal verbiage
- Identify and accurately document observations and findings
- Draft and communicate audit findings to Operations
- Research and respond to audit rebuttals
- Participate in corrective/preventive action planning and implementation related to audits
- Research issues and share the findings of that work with varying groups effectively (executives, managers, line staff, etc.)
- Identify and resolve problems independently; consult on complex issues
QualificationsYour Knowledge and Experience- Requires a high school diploma or GED
- Requires at least 7 years of prior relevant experience
- Knowledge and experience in one or more Blue Shield Operational areas, such as: Claims processing, Customer Service, Enrollment
- Audit and claims experience strongly desired
- Strong organizational skills, attention to detail, reading comprehension and analytical skills
- Strong written and verbal communication skills
HybridThis role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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