Quality Assurance​/BlueCard LOS- Auditor​/Remote

Position: Quality Assurance (BlueCard) LOS- Auditor (Remote)Quality Assurance (Blue Card) LOS
• Auditor (Remote)

Join to apply for the Quality Assurance (Blue Card) LOS
• Auditor (Remote) role at Care First Blue Cross Blue Shield.

PURPOSE: Responsible for systematic investigations of Blue Card-related transactions in specific areas such as claims or customer service within the organization. Conducts various audit activities, including process audits with a technology component and operational audits involving internal and external processes. Ensures QA testing is thorough and accurate, adhering to company policies, audit methodologies, BCBSA guidelines, and regulations.

Responsibilities:
• Perform Blue Card Plan to Plan and General Inquiry quality assurance audits to ensure system and procedure quality in line with Blue Cross Blue Shield guidelines.
• Review audit findings with internal leadership for accuracy, completeness, and fairness.
• Assist with special projects or departmental initiatives requiring subject matter expertise.

Qualifications:
• Bachelor's Degree in Business Administration, Management Sciences, Finance, Accounting, or related field, or equivalent work experience.
• At least 1 year of experience in accounting, finance, auditing, insurance, or healthcare operations.
• Proficient in Blue Card transactions and ITS software (PX Blue2, NASCO Blue2, IPDS, Blue web).
• Knowledge of Care First claim adjudication platforms (Facets G6, NASCO, Lumin

X, TMG Facets, Health Edge).
• Experience with Care First systems for Enrollment and Customer Service (Members Edge, CSW, DSC, NICE CXone).
• Strong PC skills (Outlook, Word, Excel, PowerPoint).
• Excellent analytical, research, organizational, and communication skills.
• Ability to meet deadlines and handle multiple customer service demands, providing positive service to internal and external customers.

Additional Details:
• Salary Range: $49,104 - $97,526
• Travel:
Approximately 5% to various locations.
• Employment Type:

Full-time, Entry level.
• Location:

Remote (with travel requirements).

Note: The job posting does not indicate it is expired; it appears active.
#J-18808-Ljbffr

Apply Job!

Apply to this Job