Carelon Global Solutions India
Location
Bangalore | India
Job description
ABOUT CARELON
Carelon Global Solutions (CGS) is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.
Previously known as Legato Health Technologies, Carelon Global Solutions (hereinafter, CGS) underwent a name change and joined the Carelon family of brands in January 2023, as a fully owned subsidiary of Elevance Health (Previously Anthem Inc.). CGS brings together a global team of like-minded innovators who manage and optimize operational processes for health plans as well as providers.
Our brightest minds housed across our global headquarters in Indianapolis as well as Bengaluru, Hyderabad and Gurugram in India, Manila in the Philippines, Limerick in Ireland and San Juan in Puerto Rico bring with them innovative capabilities and an unmatched depth of experience. This global team uniquely positions CGS to enable scalable, next-generation platforms and specialized digital tools that make healthcare operations more practical, effective and efficient.
JOB POSITION
Responsible for performing quality reviews, monitors regulatory integration source system(s) and reviews statistically valid sampling for accuracy daily.
Primary duties may include but are not limited to: Assists in quality assurance/improvement issues. Monitors and reports quality measures per state.
Assists in establishing quality management objectives and annual goals. Identifies, investigates, and resolves quality processing issues, and provides oversight and assistance with procedure guidelines. Resolves rebuttal issues, provides ongoing feedback to the manager regarding the performance of the regulatory integration team(s).
Job Location: Bangalore – Manyata; Gurugram
JOB RESPONSIBILITY
Quality Regulatory Review Analyst (US)
Responsible for performing quality reviews, monitors regulatory integration source system(s) and reviews statistically valid sampling for accuracy daily.
Primary duties may include but are not limited to: Assists in quality assurance/improvement issues. Monitors and reports quality measures per state.
Assists in establishing quality management objectives and annual goals. Identifies, investigates, and resolves quality processing issues, and provides oversight and assistance with procedure guidelines. Resolves rebuttal issues, provides ongoing feedback to the manager regarding the performance of the regulatory integration team(s).
Requires a BA/BS with a minimum of 3 years health care, regulatory, ethics, compliance, or privacy experience; or any combination of education and experience, which would provide an equivalent background.
QUALIFICATION
· BA/BS with a minimum of 3 years health care, regulatory, ethics, compliance, or privacy experience; or any combination of education and experience, which would provide an equivalent background
EXPERIENCE
· 4 years health care, regulatory, ethics, compliance, or privacy experience; or any combination of education and experience, which would provide an equivalent background
SKILLS AND COMPETECIES
Assists in quality assurance/improvement issues. Monitors and reports quality measures per state.
Assists in establishing quality management objectives and annual goals. Identifies, investigates, and resolves quality processing issues, and provides oversight and assistance with procedure guidelines. Resolves rebuttal issues, provides ongoing feedback to the manager regarding the performance of the regulatory integration team(s).
THE CARELON PROMISE
Aligning with our brand belief of 'limitless minds are our biggest asset', we offer a world of limitless opportunities to our associates.
It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.
This world of limitless opportunities thrives in an environment that fosters growth and well-being, and gives you purpose and the feeling of belonging.
LIFE @ CARELON
· Extensive focus on learning and development
· An inspiring culture built on innovation, creativity, and freedom.
· Holistic well-being
· Comprehensive range of rewards and recognitions
· Competitive health and medical insurance coverage
· Best-in-class amenities and workspaces
· Policies designed with associates at the center
EQUAL OPPORTUNITY EMPLOYER
Carelon is committed to a diverse and inclusive workplace and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.
Reasonable Accommodation
Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.
If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.
Disclaimer: Offered designation titles differ*
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