Performance Quality Analyst I
About The Position
The Performance Quality Analyst I drives service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise. Work includes processes related to enrollment and billing, claims processing, and written and verbal customer service inquiries. The role is based in or near San Juan or Mayagüez, Puerto Rico, and follows a hybrid schedule requiring in-office attendance one to two days per week. The position works rotating eight-hour shifts between 8:00 a.m. and 5:00 p.m. Atlantic Standard Time, Monday through Friday; additional hours, including weekends or holidays, may be required based on operational needs. Carelon Global Solutions, a fully owned subsidiary of Elevance Health, operates a bilingual Spanish- and English-language call center in Puerto Rico, providing clear and precise answers to customer queries.
Requirements
- Bachelor’s degree (BS/BA) and at least 2 years of related experience in enrollment and billing, claims, and/or a customer contact automated environment, preferably in healthcare or insurance; or an equivalent combination of education and experience.
- Ability to work in or near San Juan or Mayagüez, Puerto Rico, within reasonable commuting distance of the posting location, unless an accommodation is granted.
- Ability to work rotating eight-hour shifts between 8:00 a.m. and 5:00 p.m. AST, Monday through Friday, with additional hours, including weekends or holidays, potentially required based on operational needs.
Nice To Haves
- Full bilingual proficiency in English and Spanish, including writing, reading, and speaking.
- Healthcare industry experience.
- Previous experience supporting or participating in audits.
Responsibilities
- Assist higher-level auditors or leads with assigned field work, including special and targeted audits requested by internal management.
- Participate in pre- and post-implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment and billing transactions, and corrective action plans.
- Analyze and interpret data and recommend changes based on judgment and experience; apply audit policy and assess risks to minimize exposure and mitigate risks.
- Document audit results and findings, and suggest appropriate remediation.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs, unless covered by a collective bargaining agreement
- Medical benefits
- Dental benefits
- Vision benefits
- Short- and long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
