Performance Quality Analyst I

Anticipated End Date:

2026-04-04

Position Title:

Performance Quality Analyst I

Job Description:

Performance Quality Analyst I

Location: Puerto Rico. 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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work an 8-hour first shift, Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Our Puerto Rico location operates a bilingual Spanish and English call center, providing clear and precise answers to customer queries.

The Performance Quality Analyst I is responsible for driving service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise.  

How you will make an impact

Primary duties may include, but are not limited to:

• 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 our exposure and mitigate those risks.

• Documents audit results, documents findings, and suggests appropriate remediation.

Minimum Requirements:

• Requires a BS/BA; 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.

Preferred Skills, Capabilities, and Experiences:

• Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level.

• Minimum one-year experience in the healthcare industry preferred.

• Minimum one-year experience working with Medicare and Medicaid preferred.

Job Level:

Non-Management Non-Exempt

Workshift:

1st Shift (United States of America)

Job Family:

QLT > Analysis

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities i