Manager QA and Reporting

Manager Qa & Reporting (Healthcare)

Hybrid (In office 3 days / week) within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For :

Every day, Cambia's Operations and Compliance Team is living our mission to make health care easier and lives better. The Manager of Quality Assurance And Reporting directs, develops and leads the staff accountable for providing Health Plan Operation Quality Assurance Auditing and Reporting. Accountable for the timely and accurate external corporate reporting for the Blue Cross Blue Shield Association (BCBSA) Local Operations Scorecard (LOS) and Licensee Desk Level Audit (LDLA), as well as Performance Guarantee performance measures. Responsible for the interpretation of LOS, LDLA, and PG policies and regulations and for the implementation of the necessary statistically valid audit procedures to assess these performance measures. May also be responsible for internal high dollar prepay, staff performance auditing activities, external audit support, or compliance audits. Responsible for writing audit programs, evaluating audit results, and reporting to internal Senior Management any quality issues and areas where quality improvement is needed. Primary business contacts include BlueCross BlueShield Association, affiliate Plan LOS or LDLA peers, Member and Provider Experience, Claims, Group and Member Administration, DTS, and Provider Services Division management - all in service of making our members' health journeys easier.

If you're a motivated and experienced QA & Reporting Leader looking to make a difference in the healthcare industry, apply for this exciting opportunity today!

What You Bring to Cambia :

Preferred Key Experience :

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Qualifications and Certifications :

Skills and Attributes (Not limited to) :