Resp & Qualifications
PURPOSE:
The Quality Assurance Specialist I is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and company guidelines. Fairly and consistently reviews team interactions with both internal and external parties to ensure accuracy and support success in executing superior service and quality.
ESSENTIAL FUNCTIONS:
- 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.
Education Level: High School Diploma or GED.
Experience: 2 years progressive claims/customer service/enrollment &/or billing auditing experience, preferably in healthcare or insurance sector.
Preferred Qualifications:
- Experience processing, adjudicating or auditing claims in Facets.
Knowledge, Skills and Abilities (KSAs)
- 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
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $42,408 - $77,748
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Quality Assurance - SMMD & Lar
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
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.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
#LI-LY1
