Quality Assurance Specialist II - Healthcare Audit Compliance

Premera Blue Cross; Clayton (MO); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Premera Blue Cross seeks a Quality Specialist II to support the Provider Contact Center Quality Program. You will oversee audits such as MTM, LDLA, and FEP, ensuring compliance with state and federal laws and corporate policies.

You’ll examine daily transactions, identify quality gaps, and drive improvements across claims, enrollments and electronic exchanges. You will partner with stakeholders to strengthen quality practices, document findings, and report outcomes while supporting performance

Qualifications

• 3 years of claims, customer service, or enrollment experience including 1 year in quality audit/QA.
• High school diploma or GED required.
• Quality 101 certification; bilingual proficiency may be required.

Responsibilities

• Perform daily examination and verification of Premera transactions such as claims processing, inquiries, enrollments and EDI.
• Verify, document and communicate audit results, develop audit reports and assess corrective actions.
• Identify trends and root causes of errors and recommend improved procedures.
• Consult with external departments to resolve high impact quality issues.
• Lead and facilitate team meetings on Quality Review & Reporting initiatives and incentives.
• Explain quality principles and align audit function with organizational goals.

Skills

Quality auditing

Data analysis

Root-cause analysis

Cross-functional collaboration

Education

High school diploma or GED

Quality 101 certification

Tools

Audit software

Job description

Premera Blue Cross seeks a Quality Specialist II to support the Provider Contact Center Quality Program. You will oversee audits such as MTM, LDLA, and FEP, ensuring compliance with state and federal laws and corporate policies.

You’ll examine daily transactions, identify quality gaps, and drive improvements across claims, enrollments and electronic exchanges. You will partner with stakeholders to strengthen quality practices, document findings, and report outcomes while supporting performance