Quality Assurance Auditor, Specialist

Blue Shield of California • Oakland, CA

7d • Hybrid

About The Position

The Internal Audit team is responsible for performing compliance and contractual audits such as Licensee Desk Level Audit, Local Operations Scorecard, and Federal Employee Program. The Quality Assurance Auditor, Specialist will report to the Internal Audit Senior Manager. In this role you will be ensuring adherence to established specifications, quality standards, contractual agreements, and Blue Cross Blue Shield Association guidelines and conduct comprehensive quality reviews to identify performance deficiencies.

Requirements

• Requires a high school diploma or GED
• Requires at least 7 years of prior relevant experience
• Knowledge and experience in one or more Blue Shield Operational areas, such as: Claims processing, Customer Service, Enrollment
• Audit and claims experience strongly desired
• Strong organizational skills, attention to detail, reading comprehension and analytical skills
• Strong written and verbal communication skills

Responsibilities

• Performing transactional quality review audits with minimal supervision
• Auditing multiple areas, including Claims, Customer Service, Enrollments, etc.
• Objectively reviewing and interpreting standards, procedural documentation and contract and legal verbiage
• Identifying and accurately documenting observations and findings
• Drafting and communicating audit findings to Operations Research and responding to audit rebuttals
• Participating in corrective/preventive action planning and implementation related to audits
• Researching issues and sharing the findings of that work with varying groups effectively (executives, managers, line staff, etc.)
• Identifying and resolving problems independently; consulting on complex issues

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED