Quality Specialist II
Job description
The Quality Specialist II oversees Premera's compliance with corporate audit programs such as BCBSA Member Touchpoint Measures, Licensee Desk Level Audit and the Federal Employee Program audit, and performs daily examination and verification of transactions like claims processing, customer inquiries, enrollment and electronic data exchange. The role works with stakeholders to identify quality improvement opportunities across the company.
At a glance
- Work mode
- Remote
- Languages
- English, Spanish
- Pay
- USD 48,400 – 72,600 / year
What you'll do
- Conduct audits in a professional, ethical and objective manner using and interpreting applicable standards/requirements.
- Effectively plan, develop, and communicate an audit within a defined scope, including resource scheduling; conduct necessary meetings in performance of the audit.
- Maintain in-depth working knowledge of procedural changes, audit techniques, and plan automated systems, subsystems, and reference materials for assigned audit functions.
- Responsible for a wide variety of quality auditing tools and techniques; verify, document and communicate audit results, develop an audit report, and evaluate the effectiveness of corrective action/follow-up.
- Resolve conflict directly and respectfully, engaging in challenging and important conversations to resolve audit findings.
- Identify trends and the root cause of errors and recommend improved procedures/guidelines to Operations proactively.
- Assist in consulting with external departments to help resolve high impact key business issues surrounding quality assurance.
- Help individuals and the team become stronger by actively participating, leading and facilitating team meetings and work groups regarding Quality Review & Reporting initiatives and incentives.
- Understand quality principles as they relate to business processes and explain the importance of aligning the audit function to the organization.
- Other duties as assigned.
What we're looking for
- High school diploma or GED.
- Three (3) years of claims, customer service or enrollment work experience, which includes one (1) year of quality audit, quality control, or quality assurance experience.
Nice to have
- May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately.
- Quality 101 certification.
Your team
Provider Contact Center Quality Program
Benefits
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
For hybrid employees, an on-campus model providing flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
- Medical, vision, and dental coverage with low employee premiums.
- Voluntary benefit offerings, including pet insurance for paw parents.
- Life and disability insurance.
- Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
- Generous paid time off to reenergize.
- Tuition assistance for both undergraduate and graduate degrees.
- Employee recognition program to celebrate anniversaries, team accomplishments, and more.
- Commuter perks.
- Free convenient on-site parking.
- Subsidized on-campus cafes.
- Engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
- Complementary fitness & well-being center offering both in-person and virtual workouts and nutritional counseling.
- Shuffleboard or ping pong on campus.
Apply
About Premera Blue Cross
Join Our Team: Do Meaningful Work and Improve People's Lives
Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose, investing in employees and fostering a culture of collaboration and continuous development to better serve its customers.
Mission
To improve customers' lives by making healthcare work better.
Key facts
- Healthcare insurance
- Recognized as one of the best companies to work for
- Hiring in the following states, with some limitations based on role or city
- National Salary Range: $48,400.00 - $72,600.00
- National Plus Salary Range: $55,200.00 - $82,800.00 (used in higher cost of labor markets including Western Washington and Alaska)