Performance Quality Audit III

Elevance Health; Indianapolis (IN); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

401(k) + match

Job summary

Elevance Health, through CarelonRx, seeks a Performance Quality Audit III to evaluate the quality of services and interactions across enrollment, billing, and claims processing. You will analyze transactions and communications, document issues, and generate monthly audit reports, while mentoring quality staff in a hybrid work setting.

The role requires a strong background in insurance concepts, medical terminology, and cross-functional auditing across multiple systems and lines of business

Qualifications

• High school diploma or GED; minimum 5 years experience or equivalent background.
• Bachelor's degree strongly preferred.
• Experience with enrollment, billing, and claims processing and customer service workflows is desirable.

Responsibilities

• Evaluates the quality and accuracy of transactions and/or communications with member experience team.
• Identifies, documents, and reports errors or issues to ensure prompt resolution.
• Tracks and reports audit results and provides feedback to management.
• Identifies systemic issues causing quality concerns and reports them.
• Generates monthly audit findings reports and supports clients with issues.
• Produces ad hoc reports for internal and external clients.
• Provides training and mentoring to quality staff.
• Conducts routine to complex audits across multiple functions and systems.
• Facilitates calibration sessions with clients and teams.

Skills

Insurance industry knowledge

Medical terminology

Systems and processing knowledge

Education

High school diploma or GED

Bachelor's degree

Job description

Performance Quality Audit III

CarelonRx

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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

• 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.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health.

The Performance Quality Audit III will be 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.

How you will make an impact:

• Evaluates the quality and accuracy of transactions and/or communications with member expereince team.
• 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.
• Provides training, mentoring and support to quality staff.
• Associates at this level function as subject matter experts, conducting routine to complex audits, generally related to multiple functions on multiple systems platform for multiple lines of business.
• Works proactively and independently including facilitation of calibration sessions with clients and/or teams.

Minimum Requirements:

Requires high school diploma or equivalent (GED); minimum 5 years experience or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Working knowledge of insurance industry and medical terminology, and in-depth knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred.
• Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred.
• Bachelors degree strongly preferred.

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.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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 and financial education resources, to name a few.

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.

The health of our associates and communities is a top priority for Elevance Health. 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 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.