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A proud member of the Elevance Health family of companies, Carelon Global Solutions, formerly Legato Health Technologies is a managed service delivery organization, providing information technology and business operations services for health plans.

Performance Quality Auditor I

Schedule: This position will work a first shift monday thru friday in the hours of 9:00 am-6:00 pm Eastern Time.

The Performance Quality Auditor I is responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

How you will make an impact

Primary duties may include, but are not limited to:

• Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.

• Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

• Tracks and trends audit results, providing feedback to management.

• Identifies and reports on systemic issues which create ongoing quality concerns.

• Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.

• Produces other ad hoc reports as requested by internal and/or external clients.

• Associates at this level conduct routine audits, generally related to a single function on a single systems platform for a single line of business.

Minimum Requirements:

• Requires high school diploma or equivalent (GED); minimum 2 years experience with the company in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.

• Working knowledge of insurance industry and medical terminology and relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred.

• Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred.