Claims Quality Audit Representative 4

The Claims Quality Audit Representative 4 will also manage tertiary calibration reviews, acting as an enhanced SME to ensure that valid feedback is provided to our operational partners. The Claims Quality Audit Representative 4 will manage the calibration rebuttals process to drive continuous improvement within the team. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Exercises latitude in determining objectives and approaches to assignments.

Required Qualifications

• Strong Analytical skills with the ability to identify root causes of risks and develop robust remediation plans
• No PTO during 2 to 3 week training
• Minimum of 2 years of Healthcare experience (Medicare or Commercial or Medicaid or Medicare Dual Eligible)
• Risk management or Audit Experience
• Understanding of metrics, trends and the ability to identify gaps
• Experience driving process improvement and measuring progress
• Advanced MS office suite experience
• In-depth experience in Microsoft Excel including formulas, pivots, charts, graphs, etc.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Ability to operate under tight deadlines
• Strong attention to detail and focus on process and quality
• Excellent communication and presentation skills

Remote/Work at Home Requirements

• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Satellite and Wireless Internet service is NOT allowed for this role.
• Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Preferred Qualifications

• Ability to use data to drive business outcomes and decisions
• Bachelor's degree or equivalent experience

Additional Information

If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.