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Performance Quality Analyst I
Elevance Health. Assist higher-level auditors/leads with assigned field work, including special and targeted audits .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in auditing processes, including pre- and post-implementation audits, data analysis, and risk assessment within the healthcare or insurance sectors. Proficient in bilingual communication in English and Spanish, with a focus on enrollment, billing, and claims processing.
Highest-signal resume keywords
Audit ParticipationData AnalysisBilingual CommunicationHealthcare Industry ExperienceEnrollment And Billing Expertise
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Audit Policy ApplicationRisk AssessmentData InterpretationClaims ProcessingBenefit CodingCorrective Action PlansDocumentation Of FindingsQuality Evaluation
Soft Skills
JudgmentExperience-Based Recommendations
Industry Keywords
Healthcare SectorInsurance SectorCustomer Service InquiriesEnrollment TransactionsBilling Transactions
About the role
Key responsibilities & impact- Assist higher-level auditors/leads with assigned field work, including special and targeted audits
- Participate in pre- and post-implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment and billing transactions, and corrective action plans
- Analyze and interpret data
- Make recommendations for change based on judgment and experience
- Apply audit policy and assess risks to minimize exposure and mitigate risks
- Document audit results and findings
- Suggest appropriate remediation
- Evaluate the quality of services and interactions provided by enterprise organizations across enrollment, billing, claims processing, and customer service inquiries
Requirements
What you’ll need- Requires a BS/BA; 2+ years related experience in an enrollment and billing, claims and/or customer contact automated environment
- Experience preferably in the healthcare or insurance sector
- Any combination of education and experience providing an equivalent background
- Fully bilingual in English and Spanish, with proficiency in writing, reading, and speaking both languages preferred
- Healthcare industry experience preferred
- Previous experience supporting or participating in audits highly preferred
- Must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- Must work rotating 8-hour shifts between 8:00 am and 5:00 pm AST, Monday through Friday; additional hours, weekends, or holidays may be required based on operational needs
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work arrangement
- Flexible work-life balance
- Professional and personal growth opportunities