This job ad has been posted over 60 days ago...
0
applicants
Intermediate Quality Assurance Analyst
at Blue Shield of California in California
Helping make high-quality health care for Californians easy, accessible and affordable is a great calling. Knowing that your company has contributed over $125 million back into California communities and will continue to do so is flat out uplifting. Join the hardest working, not-for-profit health plan in California and be part of the solution.
Responsible for performing production and quality control audits to measure performance for the Medicare Claims group. Assures adherence to established CMS and internal standards. Conducts comprehensive quality review to identify performance deficiencies. May use quality analysis tools to analyze trends, root causes and identify systemic corrective action opportunities. Creates management reporting for review and follow up.
Responsibilities
Successfully exceed associate level responsibilities, in addition,
Responsible for performing audits that are semi-routine in nature
Focus on Claims and SOX audits. Considered a subject matter expert in audit principles and methodologies
Identifies and documents audit observations and findings
May review Associates work
Communicates audit issues to Supervisors immediately, provides potential solutions
Meets or exceeds departmental baseline performance and quality goals
Drafts communications to operations when necessary; forwards messaging to Supervisor for review
May participate in corrective/preventive action planning and implementation related to audits
Identifies and resolves most problems independently, consults on complex issues when necessary Works as an integral part of the larger team
Applies required job skills and policies, procedures and methods to complete assigned tasks
May participate in cross functional assignments
Interacts with operation representatives to influence outcomes
Manages timelines, assignments, and work plans
May represent BSC with internal partners and/or external entities
Education/Requirements
In addition to the skills needed for associate level:
Ability to objectively review and interpret standards, procedural documentation and contract and legal verbiage
Readily accesses information and organizational references necessary to complete tasks
Strong interpersonal and relationship building skills
Strong written and verbal communication skills
Proficient in the skills, internal procedures, and policies needed to satisfactorily complete the full range of assigned tasks.
Basic understanding of coaching/mentoring skills
Ability to meet or exceed expected deliverable due dates despite changing priorities
Strong PC skills including MS Office and BSC proprietary systems
Good organizational skills
Minimum Experience
Typically requires a minimum of 6-18 months of related experience successfully demonstrating increasingly higher level of work
Supervisory Responsibilities
Works under only very general supervision
Work is reviewed for soundness of judgment and completeness
Blue Shield of California is an Equal Opportunity Employer.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://blueshieldca.contacthr.com/20490006
Responsible for performing production and quality control audits to measure performance for the Medicare Claims group. Assures adherence to established CMS and internal standards. Conducts comprehensive quality review to identify performance deficiencies. May use quality analysis tools to analyze trends, root causes and identify systemic corrective action opportunities. Creates management reporting for review and follow up.
Responsibilities
Successfully exceed associate level responsibilities, in addition,
Responsible for performing audits that are semi-routine in nature
Focus on Claims and SOX audits. Considered a subject matter expert in audit principles and methodologies
Identifies and documents audit observations and findings
May review Associates work
Communicates audit issues to Supervisors immediately, provides potential solutions
Meets or exceeds departmental baseline performance and quality goals
Drafts communications to operations when necessary; forwards messaging to Supervisor for review
May participate in corrective/preventive action planning and implementation related to audits
Identifies and resolves most problems independently, consults on complex issues when necessary Works as an integral part of the larger team
Applies required job skills and policies, procedures and methods to complete assigned tasks
May participate in cross functional assignments
Interacts with operation representatives to influence outcomes
Manages timelines, assignments, and work plans
May represent BSC with internal partners and/or external entities
Education/Requirements
In addition to the skills needed for associate level:
Ability to objectively review and interpret standards, procedural documentation and contract and legal verbiage
Readily accesses information and organizational references necessary to complete tasks
Strong interpersonal and relationship building skills
Strong written and verbal communication skills
Proficient in the skills, internal procedures, and policies needed to satisfactorily complete the full range of assigned tasks.
Basic understanding of coaching/mentoring skills
Ability to meet or exceed expected deliverable due dates despite changing priorities
Strong PC skills including MS Office and BSC proprietary systems
Good organizational skills
Minimum Experience
Typically requires a minimum of 6-18 months of related experience successfully demonstrating increasingly higher level of work
Supervisory Responsibilities
Works under only very general supervision
Work is reviewed for soundness of judgment and completeness
Blue Shield of California is an Equal Opportunity Employer.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://blueshieldca.contacthr.com/20490006
Recent jobs at Blue Shield of California
Network Management Specialist at Blue Shield of California in California
Aug 04, 2011
Client Executive at Blue Shield of California in California
Jul 14, 2011
Large Group Underwriter at Blue Shield of California in California
Jul 02, 2011
Large Group Underwriter at Blue Shield of California in California
Jun 29, 2011
Published on Jul 14, 2011
Viewed: 224 times
Viewed: 224 times
Search Insurance Jobs by State: