El Dorado Hills, CA 95762
Full-time

Full Job Description

Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for ***** equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Your Role

The Quality Assurance Team conducts audits, documents quality issues and performance measures and conducts review of policies and procedures to ensure alignment with service level requirements. The Quality Assurance Auditor, Advanced will report to the Quality Assurance Manager. In this role they will conduct quality reviews on multiple lines of business and identify and document audit observations and findings .

Job details
Job Type
Full-time

Full Job Description

About FAIR Health

FAIR Health, Inc., an independent nonprofit organization, was established in October 2009 with the mission to help assure fairness and transparency in health insurance information. FAIR Health has created a database of over 36 billion de-identified private healthcare claim records?the largest in the country?which receives claims monthly and which serves as the foundation for a variety of data products, custom analytics and consumer tools. FAIR Health has also been certified by CMS as a ?Qualified Entity? and thus holds the entire collection of Medicare Parts A, B and D claims from 2013 to the present, which get routinely refreshed.

Our standard data modules, custom analytics and technological tools serve all participants in the healthcare sector nationwide; they are licensed to payors, third-party administrators, bill review companies, self-insured employers, government agencies, academic researchers and consultants. Our medical and dental data are used to inform statutes and regulations, healthcare cost indices, fee schedules, benefit and provider network design, practice/facility expansion, health systems research and dispute resolution, among other uses. We also offer a suite of consumer-oriented tools and resources available on our consumer website (fairhealthconsumer.org), as well as a mobile application, which can be licensed by other organizations.

Primary Responsibilities

Develop, execute and maintain all data quality and integrity checks related to benchmark data products, including data processes and deliverables
Design and execute test plans of functional and nonfunctional test cases that verify requirements and validate functionality
Work with the development team to define and execute regression testing of application changes
Identify and execute on opportunities to improve the quality assurance process, including enhancing existing quality checks by making them more dynamic, creating additional quality checks and implementing further automation and efficiencies
Translate business needs into development requirements for changes related to quality checks, bug fixes, process enhancements and automation
Write requirements, communicate/coordinate with development team(s) and test changes (including both unit and full regression testing)
Troubleshoot, debug and find root causes of errors that may occur in data processing batch jobs
Maintain documentation of workflows, data processes and implementation of development changes
Maintain standards of approving development changes and deliverables based on successful quality checks
Observe information security policies and HIPAA guidelines of conduct to assure the privacy and security of nonpublic information

Job details
Salary
$54,100 - $62,215 a year

Full Job Description
The Administration for Children’s Services (ACS) protects and promotes the safety and well-being of New York City’s children and families by providing child welfare, juvenile justice, and early care services. In child welfare, ACS contracts with private nonprofit organizations to support and stabilize families at risk of a crisis through preventive services and provides foster care services for children not able to safely remain at home. Each year, the agency’s Division of Child Protection conducts more than 55,000 investigations of suspected child abuse or neglect. In juvenile justice, ACS manages and funds services including detention and placement, intensive community-based alternatives for youth, and support services for families. In early care, ACS coordinates and funds programs and vouchers for close to 100,000 children eligible for subsidized care.


Residency Requirement
New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.