Quality Audit & Compliance Performance Specialist

Blue Shield of CA; Oakland (CA); Hybrid; USD 95,000 - 120,000; Full time

Job summary

Blue Shield of California is seeking an Operational Quality Services Auditor to join our Hybrid workplace. You will perform production and quality control audits to measure performance, assure adherence to specifications, and conduct comprehensive quality reviews to identify deficiencies.

You will analyze trends and root causes, identify systemic corrective actions, and create management reports for leadership review.

Qualifications

• Bachelor's degree or HS diploma with 4 years of relevant experience.
• Knowledge in health care compliance, legislative or legal services, healthcare, privacy, audit or investigative services preferred.
• Practical knowledge of production and quality control audits.
• Knowledge and experience with claims processing preferred.

Responsibilities

• Perform production and quality control audits to measure performance.
• Assure adherence to established specifications and quality standards.
• Conduct comprehensive quality reviews to identify performance deficiencies.
• Use quality analysis tools to analyze trends and root causes.
• Identify systemic corrective action opportunities and create management reporting for review.

Skills

Quality audits

Claims processing

Compliance awareness

Education

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

Job description

Blue Shield of California is seeking an Operational Quality Services Auditor to join our Hybrid workplace. You will perform production and quality control audits to measure performance, assure adherence to specifications, and conduct comprehensive quality reviews to identify deficiencies.

You will analyze trends and root causes, identify systemic corrective actions, and create management reports for leadership review.