Performance Quality Analyst I

The Elevance Health Companies of Puerto Rico, LLC; San Juan (PR); Hybrid; USD 42,000 - 54,000; Full time

Benefits offered by this job

Hybrid work arrangement

Paid holidays

Paid time off

Medical benefits

401(k) + match

Job summary

Elevance Health is seeking a Performance Quality Analyst I to join the Carelon Global Solutions team in Puerto Rico. The role supports enrollment, billing, and claims processing audits, with a bilingual English/Spanish requirement and healthcare industry experience.

Hybrid work model with in-office 1–2 days weekly; rotating shifts; weekend/holiday hours may be needed to meet operational needs. This position emphasizes process improvements and quality assurance.

Qualifications

• Requires a BS/BA; 2+ years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance).
• Fully bilingual (English & Spanish) with written and spoken proficiency.
• Healthcare industry experience and audit exposure are highly preferred.

Responsibilities

• Assists higher level auditor/lead on field work and audits as assigned.
• Participates in pre and post implementation audits of providers, claims processing and payment, enrollment & billing transactions and corrective action plans.
• Analyzes data, applies audit policy, assesses risks to minimize exposure and mitigate risks; documents results and remediation.

Skills

Bilingual (English/Spanish)

Audits experience

Healthcare industry experience

Education

BS/BA

Job description

Performance Quality Analyst I

The ideal candidate will be based in or near San Juan or Mayagüez, Puerto Rico.

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work rotating 8-hour shifts between 8:00 am - 5:00 pm (AST), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Carelon Global Solutions (CGS), a fully owned subsidiary of Elevance Health, is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system. Our Puerto Rico location operates a bilingual Spanish and English call center, providing clear and precise answers to customer queries.

The Performance Quality Analyst I is responsible for driving service quality excellence by 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.

How You Will Make an Impact

• Assists higher level auditor/lead on field work as assigned, including performing special audits and targeted audits as requested by internal management.
• Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions and the corrective action plan process.
• Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks.
• Documents audit results, documents findings, and suggests appropriate remediation.

Minimum Requirements

• Requires a BS/BA; 2+ years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector); or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences

• Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level preferred.
• Healthcare industry experience preferred.
• Previous experience supporting or participating in audits is highly preferred.

Job Level

Non-Management

Non-Exempt Workshift

Job Family: QLT > Analysis

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

We offer a range of market-competitive total rewards that include

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.

Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Please visit the Contract Worker Community Page.

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.