Quality Assurance Auditor, Senior, Medicare/Medi-Cal
Company: Blue Shield of California
Location: Woodland Hills
Posted on: February 24, 2021
Quality Assurance Auditor, Senior, Medicare/Medi-Cal Quality
Assurance Auditor - Responsible for performing production and
quality control audits to measure performance. Assures adherence to
established specifications and quality standards. Conducts
comprehensive quality review to identify performance deficiencies.
May use quality analysis tools to analyze trends, root causes and
identify systemic corrective action opportunities. Creates
management reporting for review and follow up.
- Responsible for performing or leading audits.
- Exercises independent judgment and initiative in resolving
complex and non-recurring problems. Responsible for accessing
documentation from all lines of business and internal and external
- Validates findings of lower level employees. Identifies areas
for improvement in upstream/downstream processes and areas of
interfacing based on acquired knowledge and recommends
improvements. Participates in corrective/preventive action
planning/implementation related to audits.
- Other duties as assigned. Organizational Impact
- Works to achieve operational targets with direct impact on
- Works independently under limited supervision.
- Work is reviewed for adequacy in meeting objectives.
- May be responsible for entire projects or processes within job
area. Innovation and Complexity
- Responsible for improving processes, systems or products to
enhance performance of the job area.
- Problems and issues faced are difficult and may require
understanding of broader set of issues. Problems typically involve
consideration of multiple issues, job areas or specialties, and are
typically solved through drawing from prior experience and analysis
- Develops new perspectives and approaches on existing problems .
Communication and Influence
- Communicates with parties within and outside of own department,
with the ability to educate others on complex disciplines.
- May have responsibility for communicating with parties'
external to the organization (e.g., customers, vendors, etc.).
- Works to influence parties within and outside of the job
function at an operational level regarding policies, practices and
procedures. Leadership and Talent Management
- May be responsible for providing guidance, coaching and
training to other employees within job area.
- May manage projects requiring the responsibility of delegating
work and reviewing resulting work product. Knowledge and Experience
- Prior audit experience in Medicare and/or Medi-Cal
- Hours of operation may include some weekends.
- Strong analytical and problem-solving skills.
- CMS/DMHC Regulatory knowledge preferred.
- Proficiency in Excel and PPT required.
- Experience with Verint is a plus.
- Typically, requires advanced knowledge of job area typically
obtained through advanced education combined with experience. May
have practical knowledge of project management.
- Typically, requires a college degree or equivalent experience
and minimum 5 years of prior relevant experience. Additional
- About Company: At Blue Shield of California we are parents,
leader, students, visionaries, heroes, and providers. Everyday we
come together striving to fulfill our mission, to ensure all
Californians have access to high-quality health care at a
sustainably affordable price. For more than 80 years, Blue Shield
of California has been dedicated to transforming health care by
making it more accessible, cost-effective, and customer-centric. We
are a not-for-profit, independent member of the Blue Cross Blue
Shield Association with 6,800 employees, more than $20 billion in
annual revenue and 4.3 million members. The company has contributed
more than $500 million to Blue Shield of California Foundation
since 2002 to have a positive impact on California communities.
Blue Shield of California is headquartered in Oakland, California
with 18 additional locations including Sacramento, Los Angeles, and
San Diego. We're excited to share Blue Shield of California has
received awards and recognition for - LGBT diversity, quality
improvement, most influential women in corporate America, Bay
Area's top companies in volunteering & giving, and one of the
world's most ethical companies. Here at Blue Shield of California,
we're striving to make a positive change across our industry and
the communities we live in - Join us!
- EEO Footer: 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
- Requisition ID: 210016F
- Posting Date: Feb 17, 2021
- Schedule: Full-time My Profile Create and manage profiles for
future opportunities. --- Woodland Hills, California, United States
of America --- Woodland Hills, California, United States of America
If you have a disability and need assistance applying for a
position with Blue Shield of California, call RehabWest, Inc. at
Keywords: Blue Shield of California, Los Angeles , Quality Assurance Auditor, Senior, Medicare/Medi-Cal, Accounting, Auditing , Woodland Hills, California
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