Quality Assurance Specialist III - Medicare/Medicaid Claims (Remote)

Resp & Qualifications

PURPOSE:
The Quality Assurance Specialist III is an advanced-level auditor position performing in-depth system and procedural audits. This role conducts regular reviews and audits of internal controls within each functional area for strengths and weaknesses ensuring special focus to the specific risk areas. The incumbent is considered a Subject Matter Expert (SME) in their audit field and provides a comprehensive analysis of transaction, systems and procedures.

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.
• Assists in development of special department projects and participates in department and divisional projects.
• Conducts structured coaching and feedback sessions. Provides suggestions and creates improvement plans for areas of deficiency within the group or for an individual.
• Participates in the creation and implementation of new methods, processes and/or products.

SUPERVISORY RESPONSIBILITY:
Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Licenses/Certifications Preferred:

• ECA Certified Quality Assurance Manager

Experience:

• 5 years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience.
• 2 years experience as Quality Assurance Specialist II.

Knowledge, Skills and Abilities (KSAs)

• Knowledge of quality assurance and production technologies.
• Proficient in Microsoft Office programs.
• Extensive of industry standards, quality control techniques and procedures.
• Excellent communication skills both written and verbal.
• Extensive analytical and problem-solving skills.
• Strong interpersonal skills.
• Excellent research and organizational 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: $53,568 - $106,392

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

Medicare/Medicaid Claims

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

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