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