Quality Assurance Auditor, Advanced

Job Description

Your Role

The Medi-Cal Claims Operations team is responsible for ensuring claims are processed accurately and timely. The Quality Assurance Auditor, Advanced will report to the Medi-Cal Operations Manager. In this role you will be responsible for performing audits that are routine in nature for the Medi-Cal line of business for all claim types.

Responsibilities

Your Work

In this role, you will :

• Be responsible for performing audits that are routine in nature where limited judgment is required.
• Focus on single area of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage.
• Identify and document audit observations and findings.
• Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging.
• Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate.
• Ability to objectively review and interpret standards, procedural documentation, contracts and legal verbiage.
• Identifies and documents audit observations and findings.
• Ability to problem solve as some issues may require some analysis to understand and resolve.
• Responsible for providing guidance, coaching, and training to other employees within job area.

Qualifications

Your Knowledge and Experience

Pay Range :

The pay range for this role is : $ 21.87 to $ 30.61 for California.

Note :

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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About the Team

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values :

Our Workplace Model :

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working :

Member-facing and approved out-of-state roles remain remote.

Physical Requirements :

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork - Activity level : Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity :

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.

Salary : $22 - $31