Quality Auditor I-1

Job description

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. About the Role: Responsible for ensuring service operations compliance with product guidelines and conducting audits. Responsibilities: Performs statistically valid audits based on the BCBSA or Performance Guarantee, and other Horizon guidelines to determine the accuracy of responses to inquiries. May conduct trending: identifying top errors and improvements, identifying strengths, escalating areas of improvement and tracking best practices. Assist in maintaining keying guidelines and disseminate quality alerts used by vendor(s). Will assist...