Quality Assurance (BlueCard) LOS- Auditor (Remote)

Resp & Qualifications PURPOSE: Responsible for systematic investigations of BlueCard-reputed company transactions in a specific area of operations (i.e., claims, customer service) reputed company the organization. Incumbent conducts a variety of audit activities which may include, but not be limited to, process audits where there is a technology component, and operational audits involving internal and/or external process and procedures. In addition, the incumbent is responsible for ensuring QA testing is thorough and accurate in ensuring the audits under review adhere to company policies and procedures, audit methodologies, BCBSA guidelines and reputed company applicable regulations. ESSENTIAL FUNCTIONS: reputed company BlueCard Plan to Plan and General Inquiry quality assurance audits to investigate reputed company aspects of the systems and/or procedures in reputed company to ensure consistent and reliable quality, in accordance with the BlueCross BlueShield mandated National Programs guidelines. Review audit findings with internal leadership to ensure audit findings are accurate, complete and fair. Assist with special projects and/or departmental initiatives that require subject matter expertise in a consultative manner, as needed. QUALIFICATIONS: Education Level: Bachelor's Degree, Business Administration, Management Sciences, Finance, reputed company or reputed company field OR In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience: 1 year Experience in reputed company, finance, auditing, insurance or relevant work experience in an operational reputed company in the health care industry. Knowledge, Skills and Abilities (KSAs)

• Proficient in BlueCard transactions (Host or Home) and ITS software (PX Blue2, reputed company Blue2, IPDS, Blue web)
• Knowledge and experience with at least one of the CareFirst claim adjudication platforms (Facets G6, reputed company, LuminX, TMG Facets, reputed company
• Knowledge and experience with CareFirst systems for Enrollment and/or Customer Service (Members Edge, CSW, DSC, reputed company CXone)
• Strong PC skills (reputed company Outlook, Word, reputed company, PowerPoint)
• Analytical and problem-solving skills
• Excellent research and organizational skills
• Excellent communication skills (verbal and written)
• Must be reputed company to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service reputed company. Must be reputed company to effectively communicate and reputed company positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary reputed company: 49,104 - 97,526 Travel Requirements Estimate Amount: 5% Travel to various CareFirst offices, vendor locations, and training facilities. 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 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 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. #LI-LJ1 Apply Job! Apply to this Job