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Quality Assurance Auditor, Experienced

Company: Blue Shield of CA
Location: San Diego
Posted on: October 13, 2019

Job Description:

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

* Service Quality Assurance - Conducts audits, documents quality issues and performance measures and conducts review of policies and procedures to ensure alignment with service level requirements.

* Quality Assurance Auditor - Responsible for performing production and quality control audits to measure performance.

* Assures adherence to established specifications and quality 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.

* Essential Responsibilities: Responsible for performing audits that are semi-routine in nature. Focus on multiple areas of expertise or lines of business (i.e. Claims, Inquiry, Enrollment)

* Considered a subject matter expert in audit principles and Methodologies. Identifies and documents audit observations and findings.

* May review lower level employee work. Communicates audit issues to Supervisors immediately, provides potential solutions Goals.

* Drafts communications to operations when necessary, forwards messaging to Supervisor for review.

* May participate in corrective/preventive action planning & implementation related to audits. Interacts with operation representatives to influence outcomes.

* Manages timelines, assignments, and work plans.

* May represent BSC with internal partners and/or external entities.

* Other duties as assigned.

* Service Quality Assurance - Conducts audits, documents quality issues and performance measures and conducts review of policies and procedures to ensure alignment with service level requirements.

* Quality Assurance Auditor - Responsible for performing production and quality control audits to measure performance.

* Assures adherence to established specifications and quality 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.

* Essential Responsibilities: Responsible for performing audits that are semi-routine in nature. Focus on multiple areas of expertise or lines of business (i.e. Claims, Inquiry, Enrollment)

* Considered a subject matter expert in audit principles and Methodologies. Identifies and documents audit observations and findings.

* May review lower level employee work. Communicates audit issues to Supervisors immediately, provides potential solutions Goals.

* Drafts communications to operations when necessary, forwards messaging to Supervisor for review.

* May participate in corrective/preventive action planning & implementation related to audits. Interacts with operation representatives to influence outcomes.

* Manages timelines, assignments, and work plans.

* May represent BSC with internal partners and/or external entities.

* Other duties as assigned.

* Requires practical knowledge of job area typically obtained through advanced education combined with experience.

* Typically, requires a college degree or equivalent experience and 3 years of prior relevant experience.

* Requires practical knowledge of job area typically obtained through advanced education combined with experience.

* Typically, requires a college degree or equivalent experience and 3 years of prior relevant experience.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Keywords: Blue Shield of CA, San Diego , Quality Assurance Auditor, Experienced, Accounting, Auditing , San Diego, California

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