Plan Quality & Performance Auditor

Blue Cross & Blue Shield of Mississippi; Flowood (MS); On-site; USD 45,000 - 60,000; Full time

Job summary

Blue Cross & Blue Shield of Mississippi is seeking a Plan Performance and Quality Reviewer to assess internal controls and ensure quality outcomes across claims adjudication, membership, and customer service. The role includes evaluating processes, coordinating MTM and PIP audits, and reporting performance improvements.

The ideal candidate will have a Bachelor’s degree or one year of claims processing experience, be proficient in Word and Excel, and demonstrate strong documentation,

Qualifications

• Must have a Bachelor’s degree or one year of experience in claims processing or adjustments.
• Must be proficient in Microsoft Office Suite to include Word and Excel.
• Strong documentation and verbal communication skills are required.
• Must be process and detail oriented to work with a high degree of accuracy and attention to detail to ensure work products are of high quality.
• Must have excellent organizational skills in order to successfully prioritize tasks and perform to ensure individual benchmarks are consistently met.
• Must demonstrate a logical thought process in order to analyze problems and identify solutions.

Responsibilities

• Evaluate the adequacy and effectiveness of internal and operational controls to ensure quality outcomes.
• Perform quality review of departmental functions including claims adjudication, membership, and customer service.
• Identify performance opportunities and report outcomes while ensuring high quality service to customers.
• Coordinate Plan audits related to Member Touchpoint Measure (MTM) and Plan Performance Incentive (PIP) ensuring points are fully met by the Plan.

Skills

Attention to detail

Organizational skills

Verbal communication

Analytical thinking

Documentation

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Job description

Blue Cross & Blue Shield of Mississippi is seeking a Plan Performance and Quality Reviewer to assess internal controls and ensure quality outcomes across claims adjudication, membership, and customer service. The role includes evaluating processes, coordinating MTM and PIP audits, and reporting performance improvements.

The ideal candidate will have a Bachelor’s degree or one year of claims processing experience, be proficient in Word and Excel, and demonstrate strong documentation,