Blue Shield of CA Looking for Quality Assurance Auditor, Advanced at Long Beach, CA  Full Time

Your Role

The Medi-Cal Claims Operations team is responsible for ensuring claims are processed accurately and timely. The Quality Assurance Auditor, Advanced will report to the Medi-Cal Operations Manager. In this role you will be responsible for performing audits that are routine in nature for the Medi-Cal line of business for all claim types.

Your Work

In this role, you will:

• Be responsible for performing audits that are routine in nature where limited judgment is required.
• Focus on single area of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage.
• Identify and document audit observations and findings.
• Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging.
• Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate.
• Ability to objectively review and interpret standards, procedural documentation, contracts and legal verbiage.
• Identifies and documents audit observations and findings.
• Ability to problem solve as some issues may require some analysis to understand and resolve.
• Responsible for providing guidance, coaching, and training to other employees within job area.

Your Knowledge and Experience

• Requires a high school diploma or GED
• Requires at least 5 years of prior relevant experience
• Minimum 5 years previous claims processing experience of all medical claim types
• Knowledge of DHCS guidelines preferred
• Prior auditing experience preferred

Pay Range:

The pay range for this role is: $ 20.82 to $ 29.15 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate’s experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.