Performance Auditor Specialist

About the Role

The Performance Auditor Specialist serves as a liaison among members, providers, care coordination teams, and internal stakeholders to ensure timely initiation, coordination, and monitoring of services while supporting operational excellence through reporting, quality assurance, data analysis, and process improvement. The specialist facilitates person‑centered care planning, monitors service initiation activities, maintains operational reporting, performs quality reviews, and supports regulatory and contractual compliance. Additionally, the role identifies operational barriers, analyzes trends, and recommends solutions to improve service delivery and member outcomes.

Key Responsibilities

• Retrieve and verify receipt of system‑generated reports, following up when reports are not received.
• Enter claims timeliness statistics for each line of business processed on Amisys.
• Create, update, and prepare workpapers for each sample.
• Prepare all claims sample listings.
• Create, update, and maintain spreadsheets documenting weekly inquiry population and sample size data.
• Compile call detail from individual workpapers for telephone tape samples.
• Perform basic audits and assist with audits as a backup.

Minimum Qualifications

• High school diploma or GED.
• 5+ years of related experience.
• Basic understanding of MTM processes and practices.
• Or any combination of education and experience that provides an equivalent background.

Preferred Skills, Capabilities, and Experience

• Experience supporting LTSS, CHOICES, ECF CHOICES, IDD, Medicaid waiver programs, or other long‑term services and supports.
• Knowledge of Person‑Centered Planning and interdisciplinary care coordination.
• Experience with provider collaboration, referral coordination, and service initiation processes.
• Experience performing operational audits, quality reviews, or claims‑related reporting.
• Experience developing operational dashboards, data analytics, and performance reporting.
• Experience leading projects, mentoring staff, or facilitating cross‑functional initiatives.
• Bachelor’s degree in Healthcare Administration, Social Work, Human Services, Public Health, Business Administration, or a related field.
• Strong analytical, problem‑solving, and organizational skills with the ability to interpret operational data, identify process improvement opportunities, manage multiple priorities, and meet deadlines.
• Excellent verbal, written, and interpersonal communication skills, with the ability to build collaborative relationships across members, providers, multidisciplinary teams, and internal stakeholders.
• Proficiency with Microsoft Office applications, including Excel and Word, as well as healthcare information systems and reporting tools.

Location and Work Arrangement

Location: Nashville, Tennessee (Tennessee residency required). Travel may be required to support provider engagement or operational needs. Hybrid schedule: associates are expected to be in‑office 1–2 days per week, with the remainder of the work performed remotely. Candidates not within a reasonable commuting distance from the posting location will not be considered unless accommodation is required by law.

Benefits

Elevance Health offers a range of market‑competitive total rewards, including merit increases, paid holidays, paid time off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short‑ and long‑term disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources.