Claims Operations & QA Specialist

Blue Shield of California

California

Hybrid

USD 58,000 - 82,000

Full time

14 days+

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Job summary

Blue Shield of California is seeking an Operations Specialist to support claims teams with end-to-end testing and defect detection for new code entering production. You will create test cases to prevent issues, collaborate across teams, and ensure adherence to state, federal or local policies.

The role emphasizes leadership development, cross-functional collaboration, and improving efficiency while maintaining compliance.

Qualifications

Bachelor’s degree or high school diploma with 4 years of related experience.
Understanding of healthcare claims processing preferred.
Experience with user acceptance testing and Agile methodologies (Jira preferred).

Responsibilities

Perform end-to-end testing on service enhancements, projects, mandates, and initiatives with thorough validation of requirements.
Review operational workflows, identify problems, and inform improvements as SME.
Track and communicate workflow and system changes to appropriate resources.
Review systems and applications and recommend system edits or changes as needed.
Notify managers about issues in operational workflow requiring immediate attention.
Contribute as SME to develop guidelines and document problems as needed.
Research source material and evaluate process flows.
Collaborate cross-functionally with internal and external teams.