Hybrid Quality Assurance Auditor – Operations & Compliance

Blue Shield of CA; Redding (CA); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Blue Shield of California is seeking an Operational Quality Services Auditor to conduct audits, document quality issues and performance measures, and review policies to ensure alignment with service level requirements. This role reports to the Operational Quality Services Supervisor and focuses on producing reports to track quality performance.

The position emphasizes a hybrid workplace with in-office collaboration two days per week, and requires a combination of education and experience in

Qualifications

• Bachelor's degree or High School Diploma/GED with 4 years of additional relevant experience in lieu of a degree
• Knowledge in health care compliance, legislative or legal services, healthcare, privacy, audit or investigative services preferred
• Practical knowledge of production and quality control audits typically obtained through advanced education combined with experience
• Knowledge and experience with claims processing preferred

Responsibilities

• Performs production and quality control audits to measure performance.
• Ensures adherence to established specifications and quality standards.
• Conducts comprehensive quality reviews to identify performance deficiencies.
• Uses quality analysis tools to analyze trends, root causes and systemic corrective actions.
• Creates management reporting for review and follow up.
• Other duties as assigned.

Education

Bachelor's degree or High School Diploma/GED with 4 years of relevant experience

Job description

Blue Shield of California is seeking an Operational Quality Services Auditor to conduct audits, document quality issues and performance measures, and review policies to ensure alignment with service level requirements. This role reports to the Operational Quality Services Supervisor and focuses on producing reports to track quality performance.

The position emphasizes a hybrid workplace with in-office collaboration two days per week, and requires a combination of education and experience in