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Quality Auditor

Company: BlueCross BlueShield of North Carolina
Location: Durham
Posted on: January 17, 2020

Job Description:

Additional Locations:Job DescriptionPerforms quality audits/reviews of departmental operations to determine effectiveness of the customer experience based on established policies, procedures and company guidelines for SMA line of business. Identifies errors and documents quality issues for management review. Recommends corrective actions and process improvements. Provides effective feedback and coaching directly to operations staff and leadership to improve performance levels and ensure understanding of departmental processes and procedures.Operational functions audited may include review of claims processing, customer service call quality, membership processing, or sales or financial process reviews. Audits may be for varied purposes, including peer reviews, high dollar claim processing, improvement of effectiveness of customer interactions and/or other individual or departmental performance improvement. Performs quality reviews of departmental operation activities to determine the accuracy of established procedures and effective operational processing. Identifies issues through review of quality results and communicates those needing further investigation to management. Provides face-to-face and/or written feedback and coaching at the individual or team level regarding quality review results to help improve individual and overall performance Researches and provides information and resources to operations staff to increase accurate processing, call handling, data entry, and resolution of issues. Identifies development needs and may work with staff to implement improvement strategies to increase overall quality. Enters results of reviews into appropriate quality database Attends and/or presents at team meetings to keep teams informed of audit activities, issues and decisions. Partners with the business area(s) to ensure procedures are current and may participate in the revision of business processes and procedures as needed.Hiring Requirements High School Diploma and 3 years (or Bachelors degree and 2 years) experience in SMA with demonstrated strong quality focus and strong critical thinking skills. Demonstrated abilities in coaching or mentoring are required (i.e. mentoring, peer feedback, training, SME). Strong technical knowledge in applicable business area required.Hiring Preferences Knowledge of Microsoft Word, PowerPoint, and Excel preferred. Health care or health insurance background is strongly preferred. Prior work experience in motivating employees through the use of performance data, goals or targets is preferred. Excellent interpersonal communication and listening skills and ability to build effective working relationships. Ability to set goals, track performance and give effective, constructive feedback. Strong written and oral communication skills, to include presentation skills. Excellent motivator with a genuine concern for others and a positive, upbeat attitude. Ability to effectively organize and balance work priorities to meet frequent role deadlines. Demonstrated attention to detail, thoroughness, and accuracy. Able to be flexible, adapt quickly to change, and work effectively in a fast paced and changing work environment. Good problem solving, critical thinking, and analytical skills. Works well independently and in teams.It's an exciting time to work at Blue Cross and Blue Shield of North Carolina. Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. Were committed to better health and better health care in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.Our company is a not-for-profit with headquarters in Durham and major operations in Winston-Salem and Fayetteville. In all we employ more than 4,900 North Carolinians and serve more than 3.9 million customers.Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.Third Party Staffing AgenciesBlue Cross NC does not accept unsolicited resumes from any source other than directly from candidates. For the protection of all parties involved in the recruiting process, resumes will only be accepted from recruiters/agencies if a signed agreement is in place at the inception of the recruiting effort and authorized for a specific position. Unsolicited resumes sent to Blue Cross NC from recruiters/agencies do not constitute any type of relationship between the recruiter/agency and Blue Cross NC and do not obligate Blue Cross NC to pay fees if we hire from those resumes.

Keywords: BlueCross BlueShield of North Carolina, Durham , Quality Auditor, Accounting, Auditing , Durham, North Carolina

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