Performance Quality Auditor (PHL)

Carelon Global Solutions Philippines, Inc.; Hinoba-an; On-site; PHP 420,000 - 540,000; Full time

Benefits offered by this job

Health and medical insurance

Rewards and recognition program

Best-in-class amenities

Job summary

Carelon Global Solutions Philippines, Inc. is seeking a Performance Quality Auditor to assess the quality and accuracy of healthcare-related transactions and communications. The role involves tracking audit results, issuing feedback to management, and producing monthly reports for clients.

A BA/BS and 3 years in quality audit (1+ year in healthcare/insurance) are required, with 100% on-site work. The position operates on a night shift from 8:00 PM to 5:00 AM in the Philippines and requires a

Qualifications

• BA/BS degree required with 3 years of experience in quality audit, with at least 1 year in healthcare or insurance.
• Strong understanding of insurance and medical terminology and processing principles.
• Willingness to work onsite and night shift (8:00 PM–5:00 AM).

Responsibilities

• Evaluate the quality and accuracy of transactions and communications with providers, groups, and policyholders.
• Identify, document, and report any transaction errors or communication issues promptly.
• Track audit results and provide feedback to management.
• Identify and report systemic issues that cause ongoing quality concerns.
• Generate monthly audit reports and support clients with issues identified.
• Produce ad hoc reports as requested by internal and external clients.
• Conduct routine to complex audits for one or more functions on one or more systems/platforms.

Skills

Quality auditing

Healthcare/insurance

Night shift

Education

BA/BS degree

Job description

Position Title: Performance Quality Auditor (PHL)

Shift: 8:00 PM to 5:00AM (Philippines)

Job Description

Responsible for 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.

Primary 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.
• Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.

Requires a BA/BS degree; 3 years of experience including a minimum of 1 year of related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.

Working knowledge of insurance industry and medical terminology, detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment required.

Additional Requirements

Active PHRN License is required With Coding and Charting experience/background 100% work onsite arrangement

Care meets innovation

Our name translates to “providing full and complete care” and reinforces our commitment to putting people first in all that we do. We specialize in contact center operations (call and chat) and clinical nurse operations for Elevance Health. With four offices in prime locations across the Philippines—two in Manila and two in Iloilo—we boast a talent pool of more than 9,000 associates all working together to improve healthcare operations. We use the right balance of care, technology, data, and expertise to streamline experiences and create value for our clients, people, and community.

We also recognize the value that our associates bring, and that is why we are committed to providing the same through competitive compensation and comprehensive benefits such as rewards and recognition programs, health and medical insurance, and best‑in‑class amenities to keep associates and their families healthy and secure. At Carelon Global Solutions Philippines, we care for those who provide care. Join us today. We celebrate and leverage our associates' limitless skills, talents, unique perspectives, and experiences. By respecting our people's culture and background, we foster a collaborative and purpose-driven workplace where everyone can grow and thrive in their careers. If you are a recent senior high school or college graduate looking to get a head start in your career, we are the right team for you. Our people-first approach supports professional development by providing associates with the right tools and training that align with their aspirations.