Quality Auditor
Location: Mountlake Terrace, Washington
Description: Premera Blue Cross is at present looking to employ Quality Auditor right now, this job will be assigned in Washington. For complete informations about this job opportunity please give attention to these descriptions. Job Summary:
The quality auditor is responsible for overseeing Premera’s compliance to corporate audit programs such as Blue Cross Blue Shield Association (BCBSA) ! and the Federal Employees Program (FEP) along with compliance to state and federal laws, contracts and achieving corporate objectives. The quality auditor performs daily examination and verification of Premera transactions, such as claims processing, customer inquiries, group and member enrollment and electronic data exchange. The auditor monitors all quality standards for selected claim, inquiry, enrollment and/or electronic transactions for accuracy, completeness and timeliness to judge the degree of adherence to the criteria set forth by the BCBSA, FEP and corporate policy requirements. The auditor will work in conjunction with stakeholders to identify opportunities for quality improvement throughout the company.
Responsibilities:
1. Thoroughly review sample items for accuracy, completeness, and timeliness to ensure transactions are conducted in accordance with the contract, federal and state mandates, benefit booklet, corporate policies, BCBSA and FE! P requirements.
2. Conduct audits in a professional, ethic! al and objective manner using and interpreting applicable standards/requirements.
3. Effectively plan, develop, and communicate an audit within a defined scope, including resource scheduling, and conducting necessary meetings in performance of the audit.
4. Maintain in-depth working knowledge of procedural changes, audit techniques, plan automated systems, subsystems, and reference materials for assigned audit functions.
5. Responsible for a wide variety of quality, auditing tools and techniques and must have the ability to verify, document and communicate audit results, develop an audit report and evaluate the effectiveness of corrective action/follow-up.
6. Communicates effectively using interpersonal skills to resolve conflict, negotiate and resolve errors. Coordinates with appropriate departments to reach consensus on error.
7. Identify trends and the root cause of errors and recommend improved procedures/guidelines, offering solutions to operations ! proactively.
8. Actively participate, lead and facilitate team meetings and workgroups regarding Quality Improvement initiatives and incentives.
9. Knowledgeable on quality principles as it relates to business processes and must be able to explain the importance of aligning the audit function to the organization.
Minimum Qualifications:
1. High school diploma or equivalent.
2. Three years of claims, customer service or enrollment work experience.
3. One year of audit experience.
4. Demonstrated advanced skills in Microsoft Office Suite: Outlook, Access, Word, Excel, and PowerPoint.
5. Excellent analytical skills â€" demonstrated ability to collect, assimilate, synthesize data using various data collection techniques and validating accuracy.
6. Excellent problem solving skills â€" demonstrated ability to solve a variety of complex problems in the absence of technical guidelines or precedents.
7. Proven ability to use! effective negotiation techniques to resolve disputes in a tactful and ! respectful manner.
8. Ability to manage change and have a pro-active approach to work.
9. Excellent presentation, written and communication skills and ability to communicate effectively with all levels of management.
10. Highly adaptable and motivated professional
11. Quality 101 certification, or ability to obtain within six months of employment.
Additional Qualifications Preferred:
1. Proven ability to successfully train others
2. Recognize and apply stages of team development: forming, storming, norming and performing.
Working Conditions:
Work is performed within a normal office environment with ambient temperatures and involves occasional reaching, stretching, bending and moving about. Travel may be required to other Premera companies on an occasional basis.
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If you were eligible to this job, please give us your resume, with salary requirements and a resume to Premera Blue Cross.
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This job will be opened on: Sat, 20 Jul 2013 13:31:29 GMT