Performance Quality Analyst I

Il y a 1 jour

MolenbeekSaintJean SintJansMolenbeek, Brussels-Capital, Belgique Elevance Health Temps plein

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Location:
The ideal candidate will be based in or near San Juan or Mayagüez, Puerto Rico. Hybrid 1: This role requires associates to be in-office 1
- 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: This position will work rotating 8-hour shifts between 8:00 am
- 5:00 pm (AST), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs. Carelon Global Solutions (CGS), a fully owned subsidiary of Elevance Health, is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system. Our Puerto Rico location operates a bilingual Spanish and English call center, providing clear and precise answers to customer queries. The Performance Quality Analyst I is responsible for driving service quality excellence by 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 Primary duties may include, but are not limited to:
• Assists higher level auditor/lead on field work as assigned, including performing special audits and targeted audits as requested by internal management.
• Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions and the corrective action plan process.
• Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks.
• Documents audit results, documents findings, and suggests appropriate remediation. Minimum Requirements
• Requires a BS/BA; 2+ years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector); or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, And Experiences
• Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level preferred.
• Healthcare industry experience preferred.
• Previous experience supporting or participating in audits is highly preferred.

Performance Quality Analyst I

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Performance Quality Analyst I

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