Quality Assurance (BlueCard) LOS- Auditor (Remote)
Resp & Qualifications
PURPOSE:
Responsible for systematic investigations of BlueCard-related transactions in a specific area of operations (i.e., claims, customer service) within the organization. Incumbent conducts a variety of audit activities which may include, but not be limited to, process audits where there is a technology component, and operational audits involving internal and/or external process and procedures. In addition, the incumbent is responsible for ensuring QA testing is thorough and accurate in ensuring the audits under review adhere to company policies and procedures, audit methodologies, BCBSA guidelines and all applicable regulations.
ESSENTIAL FUNCTIONS:
Perform BlueCard Plan to Plan and General Inquiry quality assurance audits to investigate all aspects of the systems and/or procedures in place to ensure consistent and reliable quality, in accordance with the BlueCross BlueShield mandated National Programs guidelines.
Review audit findings with internal leadership to ensure audit findings are accurate, complete and fair.
Assist with special projects and/or departmental initiatives that require subject matter expertise in a consultative manner, as needed.
QUALIFICATIONS:
Education Level: Bachelor's Degree, Business Administration, Management Sciences, Finance, Accounting or related field OR In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 1 year Experience in accounting, finance, auditing, insurance or relevant work experience in an operational capacity in the health care industry.
Knowledge, Skills and Abilities (KSAs)
• Proficient in BlueCard transactions (Host or Home) and ITS software (PX Blue2, NASCO Blue2, IPDS, Blue web)
• Knowledge and experience with at least one of the CareFirst claim adjudication platforms (Facets G6, NASCO, LuminX, TMG Facets, HealthEdge
• Knowledge and experience with CareFirst systems for Enrollment and/or Customer Service (Members Edge, CSW, DSC, NICE CXone)
• Strong PC skills (Microsoft Outlook, Word, Excel, PowerPoint)
• Analytical and problem-solving skills
• Excellent research and organizational skills
• Excellent communication skills (verbal and written)
• 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: 49,104 - 97,526
Travel Requirements
Estimate Amount: 5% Travel to various CareFirst offices, vendor locations, and training facilities.
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
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 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-LJ1
Apply Now
Apply Now
PURPOSE:
Responsible for systematic investigations of BlueCard-related transactions in a specific area of operations (i.e., claims, customer service) within the organization. Incumbent conducts a variety of audit activities which may include, but not be limited to, process audits where there is a technology component, and operational audits involving internal and/or external process and procedures. In addition, the incumbent is responsible for ensuring QA testing is thorough and accurate in ensuring the audits under review adhere to company policies and procedures, audit methodologies, BCBSA guidelines and all applicable regulations.
ESSENTIAL FUNCTIONS:
Perform BlueCard Plan to Plan and General Inquiry quality assurance audits to investigate all aspects of the systems and/or procedures in place to ensure consistent and reliable quality, in accordance with the BlueCross BlueShield mandated National Programs guidelines.
Review audit findings with internal leadership to ensure audit findings are accurate, complete and fair.
Assist with special projects and/or departmental initiatives that require subject matter expertise in a consultative manner, as needed.
QUALIFICATIONS:
Education Level: Bachelor's Degree, Business Administration, Management Sciences, Finance, Accounting or related field OR In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 1 year Experience in accounting, finance, auditing, insurance or relevant work experience in an operational capacity in the health care industry.
Knowledge, Skills and Abilities (KSAs)
• Proficient in BlueCard transactions (Host or Home) and ITS software (PX Blue2, NASCO Blue2, IPDS, Blue web)
• Knowledge and experience with at least one of the CareFirst claim adjudication platforms (Facets G6, NASCO, LuminX, TMG Facets, HealthEdge
• Knowledge and experience with CareFirst systems for Enrollment and/or Customer Service (Members Edge, CSW, DSC, NICE CXone)
• Strong PC skills (Microsoft Outlook, Word, Excel, PowerPoint)
• Analytical and problem-solving skills
• Excellent research and organizational skills
• Excellent communication skills (verbal and written)
• 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: 49,104 - 97,526
Travel Requirements
Estimate Amount: 5% Travel to various CareFirst offices, vendor locations, and training facilities.
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
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 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-LJ1
Apply Now
Apply Now