Performance Quality Analyst I (US) at Elevance Health

San Juan, Puerto Rico, Puerto Rico

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

BS/BA degree
2+ years related experience 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
Ability to work in-office 2 days per week at PR-San Juan, 654 Ave Munoz Rivera (candidates not within reasonable commuting distance will not be considered unless accommodation granted)
Ability to work 8-hour shift from 8:00 am - 5:00 pm (EDT) Monday to Friday; additional hours may be necessary based on company needs
Fully Bilingual (English & Spanish) preferred - must be able to write, read and speak both languages at a proficiency level

Responsibilities

Assists higher level auditor/lead on field work as assigned, including performing special audits and targeted audits as requested by internal management
Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions and the corrective action plan process
Analyzes and interprets data and makes recommendations for change based on judgment and experience
Applies audit policy and assesses risks to minimize exposure and mitigate those risks
Documents audit results, documents findings, and suggests appropriate remediation

Skills

audits

claims processing

billing

enrollment

customer service

benefit coding

provider inquiries

member inquiries

quality analysis

corrective action plans

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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