Job Information
Elevance Health Performance Quality Auditor III in CINCINNATI, Ohio
Title: Performance Quality Auditor III
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Performance Quality Auditor III will be 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.
How you will make an impact:
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.
Provides training, mentoring and support to quality staff.
Associates at this level function as subject matter experts, conducting routine to complex audits, generally related to multiple functions on multiple systems platform for multiple lines of business.
Works proactively and independently including facilitation of calibration sessions with clients and/or teams.
Minimum Requirements
High school diploma or equivalent (GED).
Minimum 5 years experience or any combination of education and experience which would provide an equivalent background.
Preferred Qualifications
Working knowledge of insurance industry and medical terminology, and in-depth knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred.
Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred.
Able to speak English and Spanish highly preferred .
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $29.20 to $43.79
Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, nondiscriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.