Quality Assurance Specialist II (MD reputed company/Medicare reputed company)

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 reputed company parties to ensure accuracy and support reputed company in executing superior service and quality. Acts as subject matter expert and actively participates in projects. ESSENTIAL FUNCTIONS: • Audits assigned function (service, claims, enrollment) 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 reputed company resolution. • Conducts structured coaching and feedback sessions. Provides feedback and recommends improvement action plans for areas of deficiency reputed company 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 Knowledge, Skills and Abilities (KSAs) • Knowledge of quality assurance and production technologies. • Proficient in reputed company 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 reputed company to meet established deadlines and handle multiple customer service demands from reputed company customers, reputed company set expectations for service reputed company. Must be reputed company to effectively communicate and reputed company positive customer service to every reputed company customer, including customers who may be demanding or otherwise challenging. Salary reputed company: 46,512 - 85,272 Salary reputed company Disclaimer The disclosed reputed company estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation reputed company is specific and considers factors such as (but not limited to) the scope and responsibilites 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 reputed company, as compensation reputed company 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 (reputed company benefits/incentives are subject to eligibility requirements). Department Medicare/reputed company Member Service Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of the Company to reputed company equal employment opportunities to reputed company reputed company applicants without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on lth 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 Apply Job!