Product and Group Configuration Quality Specialist II

Premera Blue Cross; United States; Remote; USD 48,000 - 83,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

401(k) match

Pension plan

Tuition assistance

Paid time off

Job summary

Premera Blue Cross seeks a skilled Quality Specialist II to audit and validate medical, dental, and pharmacy product configurations for members across the US. The role emphasizes accuracy, feedback, and continuous improvement in a telecommuting environment.

You will review configurations against source documentation, document findings, and support training to reduce recurring issues while aligning with established standards and downstream processes.

Qualifications

• High school diploma or GED (Required).
• Two (2) years of work experience in claims, customer service, membership and billing, product configuration, quality, or auditing (Required).
• One (1) year of auditing experience, such as quality review, configuration audit, operational audit, or comparable experience.
• SQL experience.
• Healthcare experience.
• Experience providing effective, constructive feedback to peers or partners to drive corrections and learning.
• Exposure to health insurance products and benefit terminology, including Medical, RX, and Dental, in a configuration, operations, or service environment.

Responsibilities

• Perform audits and testing of standard medical, dental, and pharmacy configuration work, including shells and entry-level final configurations, to verify alignment with source documentation and established processes.
• Analyze configuration outputs to confirm accuracy, completeness, and consistency prior to downstream processing.
• Deliver clear documentation of audit findings and required corrections to configuration partners.
• Support quality outcomes by providing timely, respectful, and actionable feedback that enables correction and learning.
• Analyze recurring issues and error patterns to identify trends that support training and process improvement.
• Maintain knowledge of audit procedures, configuration standards, mandates, and reference materials to ensure consistent application during audits.
• Participate in calibration discussions and quality reviews to promote consistent audit interpretation and outcomes.
• Support project work and related efforts aligned to team priorities.
• Other duties as assigned.

Tools

SQL

Job description

Workforce Classification:

Telecommuter

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

Premera is committed tobeinga workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development,we’reable to better serve our customers.It’sthis commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.

Ready to take the next step in your career and make a meaningful impact on the quality of our customers’ experience? This is an exciting opportunity for an internal candidate to build on their knowledge of our business, systems, and customers while developing valuable expertise in product and group configuration quality. Join a collaborative team where your attention to detail, operational insight, and commitment to continuous improvement will help ensure benefits are configured accurately—and where you can grow from foundational audits into increasingly complex and influential work.

Product & Group Configuration Quality Specialist II will support accurate customer benefit delivery by performing foundational audits of product configuration and group setup across medical, dental, and pharmacy. The role will review configuration outputs against source documentation and established standards to identify discrepancies and ensure corrections are completed prior to downstream processing impacts. The position will contribute to quality and consistency by providing clear, actionable feedback and applying standard audit practices. The role will focus on skill development through foundational audit work with progression to more complex audits as proficiency increases.

What you will do:

• Perform audits and testing of standard medical, dental, and pharmacy configuration work, including shells and entry-level final configurations, to verify alignment with source documentation and established processes.
• Analyze configuration outputs to confirm accuracy, completeness, and consistency prior to downstream processing.
• Deliver clear documentation of audit findings and required corrections to configuration partners.
• Support quality outcomes by providing timely, respectful, and actionable feedback that enables correction and learning.
• Analyze recurring issues and error patterns to identify trends that support training and process improvement.
• Maintain knowledge of audit procedures, configuration standards, mandates, and reference materials to ensure consistent application during audits.
• Participate in calibration discussions and quality reviews to promote consistent audit interpretation and outcomes.
• Support project work and related efforts aligned to team priorities.
• Other duties as assigned.

What you will bring:

• High school diploma or GED (Required).
• Two (2) years of work experience in one or more of the following areas: claims, customer service, membership and billing, product configuration, quality, or auditing, including experience using relevant systems and processes (Required).
• One (1) year of auditing experience, such as quality review, configuration audit, operational audit, or comparable experience.
• SQL experience.
• Healthcare experience.
• Experience providing effective, constructive feedback to peers or partners to drive corrections and learning.
• Exposure to health insurance products and benefit terminology, including Medical, RX, and Dental, in a configuration, operations, or service environment.

What you will gain:

Analytical judgment — evaluating complex information, spotting subtle inconsistencies, and determining appropriate next steps.

Root-cause thinking — moving beyond individual errors to understand why issues occur and how to prevent them.

Influential communication — delivering feedback that builds trust, encourages learning, and leads to action.

Systems thinking — understanding how configuration decisions affect customers and downstream business processes.

Professional adaptability — building confidence with increasingly complex work, evolving standards, and changing priorities.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they’re a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• 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, believe it or not, a pension plan that is vested after 3 years of service.
• 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, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [e-mail] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city:

Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin_._

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

$48,400.00 - $72,600.00

National Plus Salary Range:

$55,200.00 - $82,800.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska _._

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.