Quality Assurance Specialist II (Remote)

Overview The Quality Specialist II is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and company guidelines. They fairly and consistently review team interactions with both internal and external parties to ensure accuracy and support success in executing superior service and quality. The role serves as a subject matter expert and actively participates in projects. Responsibilities Audits assigned function claims for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors using departmental quality monitoring templates in a timely manner to ensure prompt resolution. Conducts structured coaching and feedback sessions. Provides feedback and recommends improvement action plans for areas of deficiency within 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 the manager. Assists in development of special department projects and participates in divisional projects. Qualifications Education Level: High School Diploma or GED. Experience: 5 years in Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience. Must have claims processing experience in Facets/G6 systems. Knowledge, Skills And Abilities (KSAs): Knowledge of quality assurance and production technologies. Proficient in Microsoft 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. Ability to meet established deadlines and handle multiple customer service demands from internal and external customers, including demanding or challenging interactions. Salary Range $47,880 - $87,780 Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. 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 Must be eligible to work in the United States without sponsorship. #J-18808-Ljbffr