Full-Time

Quality Audit Specialist

Posted on 10/28/2024

HCSC

HCSC

Health insurance provider in multiple states

Financial Services
Healthcare

Compensation Overview

$17.5 - $36.76Hourly

Junior, Mid

Chicago, IL, USA

Hybrid schedule requires 3 days in office at 300 E. Randolph, 8am - 4:30pm.

Category
Auditing
Accounting
Required Skills
Data Analysis
Requirements
  • High school diploma or GED.
  • 2 years in a health care production or health care provider services production environment.
  • 2 years’ experience where quality audits are performed.
  • Clear and concise interpersonal, verbal and written communication skills.
  • Knowledge of Managed Care products, programs, and services.
  • Knowledge of managed care providers and provider databases.
  • Analytical skills; organizational skills; and timely assignment completion of daily work and/ or assigned projects.
  • PC experience and skills to include Word, Excel, Access, Dashboard, Blue Star, Vistar or similar word processing spreadsheets (Windows environment) software.
Responsibilities
  • Ensuring the accuracy of auditing IE, Hedis, Ncqa data.
  • Documenting quality performance audits.
  • Maintaining quality assurance statistics.
  • Custodian for the department record retention processes.
  • Participates in Hedis administrative (clerks) interviews.
  • Develops a training manual.
  • Provides training and coordinates daily tasks of the Hedis clerks.
  • As a Qi team member, provide support of disease management and clinical intervention activities as directed.
  • Conducts auditing of quality of service complaints, which include: reviewing service complaints; developing tracking system for complaints; generating form letters; identifying provider/clinics; assessing, and researching the complaint; analyzing, resolving and communicating resolution of the quality of service complaint to members; notifying providers and network services of the complaint and its resolution.

HCSC provides health insurance services across five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. The company offers a variety of health insurance plans designed for individuals, families, and businesses, ensuring that different healthcare needs are met. HCSC's plans work by collecting premiums from members, which then fund the healthcare services covered under these plans. What sets HCSC apart from other health insurance providers is its strong focus on health and wellness programs aimed at reducing overall healthcare costs and improving the health outcomes of its members. The goal of HCSC is to be a reliable partner in health, promoting quality care and supporting individuals in leading healthier lives.

Company Stage

N/A

Total Funding

$472.7M

Headquarters

Chicago, Illinois

Founded

1936

Simplify Jobs

Simplify's Take

What believers are saying

  • HCSC's acquisition of Cigna's Medicare businesses expands its capabilities in the growing Medicare market.
  • The new Houston office expansion will create job opportunities and drive local economic growth.
  • Rising telehealth adoption allows HCSC to expand its virtual care offerings.

What critics are saying

  • Integration challenges with Cigna's Medicare businesses could affect service delivery and financial performance.
  • Economic downturns in Texas may impact the success of HCSC's Houston office expansion.
  • Increased competition in the Medicare market could impact HCSC's market share.

What makes HCSC unique

  • HCSC's nearly century-long experience establishes it as a trusted health insurance provider.
  • The company offers comprehensive health plans tailored to diverse client needs across five states.
  • HCSC invests in health and wellness programs to reduce costs and improve member outcomes.

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