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Jobs · Quality Assurance · Maryland

Quality Assurance Specialist III (Remote)

CareFirst BlueCross BlueShield · Baltimore, MD · 1 mo ago
On-siteQuality Assurance$56k–$111k/yrFull-time

Purpose and Responsibilities

The Quality Assurance Specialist III is an advanced‑level auditor performing in‑depth system and procedural audits. This role conducts regular reviews of internal controls within each functional area, focusing on specific risk areas, and serves as a Subject Matter Expert (SME) in the audit field.

  • Audit assigned function (claims) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures.
  • Identify, document, and report transaction errors using departmental quality monitoring templates in a timely manner to ensure prompt resolution.
  • Assist in the development of special department projects and participate in department and divisional projects.
  • Conduct structured coaching and feedback sessions; provide suggestions and create improvement plans for areas of deficiency.
  • Participate in the creation and implementation of new methods, processes, and/or products.

Supervisory Responsibility

This position has no direct reports but is expected to guide and mentor less experienced staff and may lead a team of matrixed resources.

Qualifications

  • Education: High School Diploma or GED.
  • Experience: 5 years in Auditing, Quality Assurance, Operations, Training, Project Management, or comparable work experience.
  • 2 years experience as a Quality Assurance Specialist II.

Preferred Qualifications

  • G6 claims experience.
  • Licenses/Certifications: ECA Certified Quality Assurance Manager.

Knowledge, Skills, and Abilities

  • Knowledge of quality assurance and production technologies.
  • Proficiency in Microsoft Office programs.
  • Extensive knowledge of industry standards, quality control techniques, and procedures.
  • Excellent written and verbal communication skills.
  • Strong analytical and problem‑solving abilities.
  • Strong interpersonal skills.
  • Excellent research and organizational skills.

Salary Range

$55,656 – $110,539. The disclosed range has not been adjusted for geographic differentials and reflects factors such as scope of responsibilities, experience, education, internal equity, and market considerations.

Benefits

CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401(k) contribution programs/plans (subject to eligibility requirements).

Physical Demands

The associate is primarily seated while performing duties. Occasional walking or standing is required. Hands are regularly used to write, type, and handle small objects. Frequent talking and hearing are required. Occasionally lifts weights up to 25 pounds.

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status, disability, or genetic information.

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