Performance Quality Auditor III (US)

About the position

The Performance Quality Auditor III is responsible for evaluating the quality of services and interactions provided by organizations within Elevance Health. This role focuses on assessing processes related to enrollment, billing, claims processing, and customer service inquiries, ensuring accuracy and quality in transactions and communications.

Responsibilities
? Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
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? Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
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? Tracks and trends audit results, providing feedback to management.
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? Identifies and reports on systemic issues which create ongoing quality concerns.
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? Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
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? Produces other ad hoc reports as requested by internal and external clients.
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? Provides training, mentoring and support to quality staff.
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? Conducts routine to complex audits related to multiple functions on the WGS claims system for multiple lines of business.
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? Works proactively and independently including facilitation of calibration sessions with clients and/or teams.

Requirements
? High school diploma or equivalent (GED).
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? Minimum 5 years' experience or any combination of education and experience which would provide an equivalent background.

Nice-to-haves
? WGS claims system experience and knowledge is strongly preferred.
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? Working knowledge of insurance industry and medical terminology.
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? In-depth knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred.
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? Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred.

Benefits
? Comprehensive benefits package
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? Incentive and recognition programs
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? Equity stock purchase
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? 401k contribution
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? Paid holidays
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? Paid Time Off
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? Medical, dental, vision benefits
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? Short and long term disability benefits
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? Life insurance
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? Wellness programs
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? Financial education resources

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