Quality Assurance Specialist I (Remote)

Summary

CareFirst BlueCross BlueShield is seeking a Quality Assurance Specialist I to examine and evaluate transaction accuracy in accordance with regulations and company guidelines. The role audits service, claims, and enrollment functions, identifies and reports errors, mentors less-tenured associates, and identifies quality trends and training opportunities.

Responsibilities

• Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution
• Performs in the role of coach and mentor to less tenured associates and acts as a subject matter expert on the Operations.. Assist with cross-training and skill development activities with less experienced staff in conjunction with management team
• Proactively identifies trends and training opportunities based on quality evaluations

Skills

• High School Diploma or GED
• 2 years progressive claims/customer service/enrollment &/or billing auditing experience, preferably in healthcare or insurance sector
• Basic knowledge of quality assurance and production technologies
• Proficient in Microsoft Office programs
• Basic knowledge of industry standards, quality control techniques and procedures
• Excellent communication skills both written and verbal
• Excellent Research and organizational skills
• Excellent decision making and interpersonal skills
• The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted
• Must be eligible to work in the U.S. without Sponsorship

Qualifications

Must Haves

• High School Diploma or GED
• 2 years progressive claims/customer service/enrollment &/or billing auditing experience, preferably in healthcare or insurance sector
• Basic knowledge of quality assurance and production technologies
• Proficient in Microsoft Office programs
• Basic knowledge of industry standards, quality control techniques and procedures
• Excellent communication skills both written and verbal
• Excellent Research and organizational skills
• Excellent decision making and interpersonal skills
• The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted
• Must be eligible to work in the U.S. without Sponsorship

Benefits

• A comprehensive benefits package, subject to eligibility requirements.
• Various incentive programs/plans, subject to eligibility requirements.
• 401k contribution programs/plans, subject to eligibility requirements.