Resp & Qualifications

PURPOSE:
The Quality Specialist II is responsible for examining and evaluating the accuracy of transactions in accordance with regulations, and company guidelines. Fairly and consistently reviews team interactions with both internal and external parties to ensure accuracy and support success in executing superior service and quality. Acts as subject matter expert and actively participates in projects.

ESSENTIAL FUNCTIONS:

Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing 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 manager. Assists in development of special department projects and participates in divisional projects.

QUALIFICATIONS:

Education Level: High School Diploma or GED
Experience: 5 years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience

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.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  
  Salary Range: $46,512 - $85,272
  Salary Range Disclaimer
  
  The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range 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 range, as compensation decisions 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 (all benefits/incentives are subject to eligibility requirements).
  Department
  
  Medicare/Medicaid Member Service
  Equal Employment Opportunity
  
  CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide 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.
  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 perform work directly or indirectly on lth 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