Quality Assurance Auditor (Remote)

**Resp \& Qualifications** **PURPOSE:** Responsible for systematic investigations of a specific area of operations (i.e., claims, customer service, enrollment) within the organization. Incumbent conducts a variety of audit activities which may include, but not be limited to, process audits where there is a technology component, operational audits involving internal and/or external process and procedures, and audits of vendors/partner contracted services. In addition, the incumbent is responsible for ensuring QA testing is thorough and accurate in ensuring the audits under review adhere to company policies and procedures, audit methodologies, BCBSA guidelines and all applicable regulations. **ESSENTIAL FUNCTIONS:** * Perform quality assurance audits to investigate all aspects of the systems and/or procedures in place to ensure consistent and reliable product quality. Review the official lines of authority put in place to drive Q/A initiatives, the systems put in place to continually drive product quality higher and the monitoring of systems and/or procedures used to review the effectiveness of Q/A efforts. * Submit audit findings to assigned client areas and leadership that outline the root cause of identified issues as well as provide recommendations for corrective action, system and procedural modification and enhancements to improve service and quality. Issues may include, but are not limited to: weaknesses, inconsistencies and inaccuracies in procedures, controls and system integrity. Compile, analyze and report any fraudulent activity or information to the appropriate departments. This information or activity may represent a potential risk to the organization, its subscribers, accounts and providers. * Monitor operations and test outputs to ensure consistent quality by identifying errors and opportunities to improve. Review audit findings with both the assigned client group and leadership to ensure audit findings are accurate, fair and agreement ha