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Performance Quality Auditor I, II, III

Location:
JobFamily: Quality
Req #: PS59114
Date Posted: Dec 2, 2021

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

Primary duties may include, but are not limited to:

  • 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 external clients.
  • Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.

Qualifications

  • Requires high school diploma or equivalent (GED)
  • 3 years’ experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector) with consistent above target performance; working knowledge of insurance industry and medical terminology; detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment or any combination of education and experience which would provide an equivalent background.

Preferred: 

  • Pharmacy Certificate

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.