Resp & Qualifications

PURPOSE: 
The Quality Specialist II is responsible for examining and evaluating the accuracy of transactions in accordance with regulations, and company guidelines. Fairly and consistently reviews team interactions with both internal and external parties to ensure accuracy and support success in executing superior service and quality. Acts as subject matter expert and actively participates in projects. 

ESSENTIAL FUNCTIONS:

• Audits assigned function claims for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution.
• Conducts structured coaching and feedback sessions.  Provides feedback and recommends improvement action plans for areas of deficiency within the group or for an individual.   
• Participates in the creation and implementation of new methods, processes and/or products    
• Prepares reports and submits them to manager. Assists in development of special department projects and participates in divisional projects.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 5 years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience. Must have claims processing experience in Facets/G6 systems.

Knowledge, Skills and Abilities (KSAs) 

• Knowledge of quality assurance and production technologies.
• Proficient in Microsoft Office programs.
• Knowledge of industry standards, quality control techniques and procedures.
• Excellent communication skills both written and verbal.
• Excellent research and organizational skills.
• Strong Interpersonal skills.
• Extensive analytical and problem solving skills. 
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $47,880 - $87,780

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship