PERFORMANCE QUALITY AUDITOR III (US)
Company: Elevance Health
Location: Grand Prairie
Posted on: October 3, 2024
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Job Description:
Location: Elevance Health supports a hybrid workplace model
(virtual and in-office) with PulsePoint sites used for
collaboration, community, and connection. This includes remote work
and 1-2 days in office per week. Candidates must reside within a
50-mile or 1-hour commute each way of a relevant Elevance Health
location.The Performance Quality Auditor lll is responsible
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
ImpactPrimary 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.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 the WGS claims system for multiple lines of
business.Works proactively and independently including facilitation
of calibration sessions with clients and/or teams.Minimum
Requirements:Requires high school diploma or equivalent (GED);
minimum 5 years' experience or any combination of education and
experience which would provide an equivalent background.Preferred
Skills, Capabilities and Experiences:WGS claims system experience
and knowledge is strongly preferred.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.For candidates working in person or
remotely in the below location(s), the salary* range for this
specific position is $39.21 - $64.17 (Hourly)Locations: Colorado;
New YorkIn 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, non-discriminatory 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.Please be
advised that Elevance Health only accepts resumes for compensation
from agencies that have a signed agreement with Elevance Health.
Any unsolicited resumes, including those submitted to hiring
managers, are deemed to be the property of Elevance Health.Who We
AreElevance Health is a health company dedicated to improving lives
and communities - and making healthcare simpler. We are a Fortune
25 company with a longstanding history in the healthcare industry,
looking for leaders at all levels of the organization who are
passionate about making an impact on our members and the
communities we serve.How We WorkAt Elevance Health, we are creating
a culture that is designed to advance our strategy but will also
lead to personal and professional growth for our associates. Our
values and behaviors are the root of our culture. They are how we
achieve our strategy, power our business outcomes and drive our
shared success - for our consumers, our associates, our communities
and our business.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.Elevance Health operates in a Hybrid Workforce Strategy.
Unless specified as primarily virtual by the hiring manager,
associates are required to work at an Elevance Health location at
least once per week, and potentially several times per week.
Specific requirements and expectations for time onsite will be
discussed as part of the hiring process. Candidates must reside
within 50 miles or 1-hour commute each way of a relevant Elevance
Health location.The health of our associates and communities is a
top priority for Elevance Health. We require all new candidates in
certain patient/member-facing roles to become vaccinated against
COVID-19. If you are not vaccinated, your offer will be rescinded
unless you provide an acceptable explanation. Elevance Health will
also follow all relevant federal, state and local laws.Elevance
Health is an Equal Employment Opportunity employer and all
qualified applicants will receive consideration for employment
without regard to age, citizenship status, color, creed,
disability, ethnicity, genetic information, gender (including
gender identity and gender expression), marital status, national
origin, race, religion, sex, sexual orientation, veteran status or
any other status or condition protected by applicable federal,
state, or local laws. Applicants who require accommodation to
participate in the job application process may contact
elevancehealthjobssupport@elevancehealth.com for assistance.
Keywords: Elevance Health, DeSoto , PERFORMANCE QUALITY AUDITOR III (US), Accounting, Auditing , Grand Prairie, Texas
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