Healthcare Quality Assurance Specialist II

Premera Blue Cross; Clifton (TX); Híbrido; USD 65.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

On-site parking

Health and wellness center

On-site activities

Shuffleboard / Ping Pong on campus

Tuition assistance

Descripción de la vacante

Premera Blue Cross is seeking a Quality Specialist II to oversee compliance with audit programs across our offshore operations. You will partner with teams to identify opportunities, strengthen quality practices, and drive improvements that impact claims processing, inquiries, enrollments and data exchange.

You will perform daily examination and verification of transactions, monitor quality standards for accuracy and timeliness, and support cross-functional efforts to align the audit function

Formación

• Three (3) years of claims, customer service or enrollment work experience, including one (1) year of quality audit, quality control, or quality assurance experience.
• May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately.
• Quality 101 certification. Build expertise in quality auditing and compliance standards.

Responsabilidades

• Maintain in-depth working knowledge of procedural changes, audit techniques, and plan automated systems, subsystems, and reference materials for assigned audit functions.
• Verify, document and communicate audit results, develop an audit report, and evaluate the effectiveness of corrective action/follow-up.
• 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.
• The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone.

Conocimientos

Data analysis

Root-cause analysis

Quality auditing

Quality assurance

Team collaboration

Educación

High school diploma or GED

Herramientas

Quality auditing tools

Descripción del empleo

Premera Blue Cross is seeking a Quality Specialist II to oversee compliance with audit programs across our offshore operations. You will partner with teams to identify opportunities, strengthen quality practices, and drive improvements that impact claims processing, inquiries, enrollments and data exchange.

You will perform daily examination and verification of transactions, monitor quality standards for accuracy and timeliness, and support cross-functional efforts to align the audit function