Performance Quality Auditor I (US)

$42,432 - $63,648/Yr

Elevance Health - Woburn, MA

Full-time - Entry Level

Woburn, MA

11-50 employees

Insurance Carriers and Related Activities

About the position

The Performance Quality Auditor I is responsible for evaluating the quality of services and interactions provided by organizations within the enterprise, focusing on processes related to enrollment, billing, claims processing, and customer service inquiries. This role involves conducting routine audits, identifying errors, and generating reports to support management and clients.

Responsibilities

• Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
• Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
• Tracks and trends audit results, providing feedback to management.
• Identifies and reports on systemic issues which create ongoing quality concerns.
• Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
• Produces other ad hoc reports as requested by internal and/or external clients.

Requirements

• High school diploma or equivalent (GED).
• Minimum 2 years experience with the company in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector).
• Any combination of education and experience which would provide an equivalent background.

Nice-to-haves

• Working knowledge of insurance industry and medical terminology and relevant systems.
• Proven understanding of processing principles, techniques and guidelines.
• Ability to acquire and perform progressively more complex skills and tasks in a production environment.
• Proficient in MS Office.
• Prior experience processing claims.
• Experience with CAS and FlexCare systems.

Benefits

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