Operational Quality Services Specialist, Associate

Blue Shield of CA; Los Angeles (CA); Hybrid; USD 65,000 - 95,000; Full time

Job summary

The Operational Quality Services Auditor at Blue Shield of CA will conduct production and quality control audits to measure performance and ensure adherence to established specifications and quality standards. The position involves documenting quality issues, reviewing policies and procedures, and creating management reports for follow-up, with a focus on root-cause analysis and corrective actions.

This is a hybrid role requiring in-office presence two days per week, with scheduling based on

Qualifications

• Must have a Bachelor's degree or equivalent experience or 4 years additional experience in lieu of a degree.
• Knowledge in health care compliance, legislative or legal services, healthcare, privacy, audit or investigative services preferred.
• Experience with production and quality control audits and claims processing is advantageous.

Responsibilities

• Perform production and quality control audits to measure performance.
• Document quality issues and performance measures and conduct reviews of policies and procedures.
• Create management reporting for review and follow up; identify root causes and corrective actions.

Job description

Your Role

The Operational Quality Services team conducts audits, documents quality issues and performance measures and conduct reviews of policies and procedures to ensure alignment with service level requirements. The Operational Quality Services Auditor will report to the Operational Quality Services Supervisor. In this role you will be responsible for performing production and quality control audits to measure performance. Assures adherence to established specifications and quality standards. Conducts comprehensive quality review to identify performance deficiencies. May use quality analysis tools to analyze trends, root causes and identify systemic corrective action opportunities. Creates management reporting for review and follow up. Other duties as assigned.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Bachelor's degree or High School Diploma/GED and 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

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.