Performance Quality Auditor PHL

Elevance Health; Philippines; On-site; PHP 480,000 - 600,000; Full time

Job summary

Elevance Health is seeking a Performance Quality Auditor in the Philippines to assess service quality across enrollment, billing, claims processing, and customer interactions. The role conducts audits from routine to complex across systems and business lines, reports findings monthly, and supports issue resolution with management.

Requirements include a BA/BS degree, 3 years in quality audit (1 year in healthcare/insurance), PHRN license, and 100% onsite work.

Qualifications

• BA/BS degree required with at least 3 years of quality audit experience, preferably in healthcare or insurance.

Responsibilities

• Evaluate the quality of transactions and communications with providers, groups and policyholders.
• Identify, document and report transaction errors or communication issues for prompt resolution.
• Track and report audit results and trends; provide feedback to management.

Skills

Quality audit

Healthcare knowledge

Coding and Charting

Education

BA/BS degree

Job description

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