Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Performance Quality Auditor I
Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.
Primary duties may include, but are not limited to:
Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
Tracks and trends audit results, providing feedback to management.
Identifies and reports on systemic issues which create ongoing quality concerns.
Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
Produces other ad hoc reports as requested by internal and/or external clients.
Associates at this level conduct routine audits, generally related to Enrollment processes housed in multiple systems for a single line of business.
Requires high school diploma or equivalent (GED);
2 years experience with the company in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector);
Working knowledge of insurance industry and medical terminology;
Working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines;
Ability to acquire and perform progressively more complex skills and tasks in a production environment
Or any combination of education and experience, which would provide an equivalent background.
Related quality auditing experience preferred, including providing feedback to associates regarding the audit performed on their work.
Proficiency in Microsoft Excel, Word, and Outlook preferred.
System knowledge in Facets, Macess, Microsoft Access, and Compass preferred.
Strong attention to detail, multi-functional processing, ability to multi task, and meet deadlines preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc. Top 50 Company, for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.