Healthcare Quality Assurance Specialist II

Premera Blue Cross; New Hampshire; On-site; USD 68,000 - 82,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) employer match

Tuition assistance

On-site parking

Well-being center

Job summary

Premera Blue Cross in New Hampshire is seeking a Quality Specialist II to oversee audit programs across claims, inquiries, enrollments and electronic transactions. You will verify data, monitor quality standards, and drive improvements with stakeholders.

The role requires a high school diploma or GED with 3 years in relevant areas, including 1 year in quality auditing. Familiarity with bilingual communication and Quality 101 is a plus.

Qualifications

• High school diploma or GED is required.
• 3 years of claims, customer service or enrollment work experience, including 1 year in quality audit, quality control, or quality assurance.
• May require bilingual proficiency (English/Spanish) for clear communication.
• Quality 101 certification and building expertise in quality auditing and compliance are expected.

Responsibilities

• Oversee Premera’s compliance with audit programs (BCBSA MTM, LDLA, FEP).
• Examine and verify Premera transactions (claims, inquiries, enrollments, electronic data exchange).
• Monitor quality standards for accuracy, timeliness and completeness.
• Develop audit reports and evaluate corrective action effectiveness.
• Identify trends and root causes to improve procedures; consult with external departments as needed.
• Lead and participate in team meetings for Quality Review & Reporting initiatives and incentives.

Skills

Quality auditing

Data analysis

Root-cause analysis

Communication

Team collaboration

Education

High school diploma or GED

Job description

Premera Blue Cross in New Hampshire is seeking a Quality Specialist II to oversee audit programs across claims, inquiries, enrollments and electronic transactions. You will verify data, monitor quality standards, and drive improvements with stakeholders.

The role requires a high school diploma or GED with 3 years in relevant areas, including 1 year in quality auditing. Familiarity with bilingual communication and Quality 101 is a plus.