Performance Quality Analyst III (Claims)

Anticipated End Date:

2025-06-20

Position Title:

Performance Quality Analyst III (Claims)

Job Description:

Performance Quality Analyst III (Claims)

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

The Performance Quality Analyst III (Claims) is responsible for driving service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise.  Included are processes related to claims processing, as well as written and verbal inquiries. 

How you will make an impact:  

• Acts as auditor in charge for audits and special projects, producing engagement planning and testing strategies.

• Translates business need into appropriate, comprehensive quality validation strategies and design.

• 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.

• Audits multiple lines of business, multiple functions, and multiple systems.

• Trend audit results and perform data analysis on trends to determine/recommend adjustments to quality reviews.

• Work closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.

• Manage process improvement process.

• May include activities such as leading workgroups, facilitating SWAT sessions, drafting new workflow or procedures.

• Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.

• Facilitate and lead meetings with business to review audit plan, audit findings and/or recommendations for improvement.

• Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.

• Facilitate calibration sessions with the business area, support areas, vendors or clients.

Minimum Requirements:

Requires a BS/BA; a minimum of 5 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.

Preferred Skills, Capabilities, and Experiences:

• WGS Experience Claims Processing including 1 year related experience in a quality audit capacity or any combination of education and experience which would provide an equivalent background.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $62,128 to $97,428.

Locations: Woodland Hills, CA

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefit