Quality Assurance Specialist II — Healthcare Audit & Compliance

Premera Blue Cross; Florida; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

401K with company match

Tuition assistance

On-site resources and wellness center

Job summary

Premera Blue Cross in the United States seeks a Quality Specialist II to oversee audits and drive improvements across claims, enrollments, and electronic exchanges. You will partner with stakeholders to ensure BCBS MTM/LDLA and FEP compliance and support corporate objectives.

The role focuses on data analysis, root-cause problem solving, and coaching teams to strengthen quality practices while maintaining timeliness and accuracy in offshore operations.

Qualifications

• High school diploma or GED.
• Three years of claims, customer service or enrollment work experience, including one year in quality audit/quality assurance.
• Possible bilingual proficiency in English/Spanish depending on language needs.
• Quality 101 certification.
• Build expertise in quality auditing and compliance standards.

Responsibilities

• Maintain in-depth knowledge of audit techniques and procedures.
• Verify, document and communicate audit results and corrective actions.
• Identify trends and root causes; recommend improved procedures.
• Consult with external departments to resolve quality issues.
• Lead and participate in team meetings on quality review and reporting.
• Explain quality principles and align audit activities with organizational goals.
• Keyboard and clear communication required for on-site work.

Skills

Quality auditing

Data analysis

Root cause analysis

Team collaboration

Communication skills

Education

High school diploma or GED

Job description

Premera Blue Cross in the United States seeks a Quality Specialist II to oversee audits and drive improvements across claims, enrollments, and electronic exchanges. You will partner with stakeholders to ensure BCBS MTM/LDLA and FEP compliance and support corporate objectives.

The role focuses on data analysis, root-cause problem solving, and coaching teams to strengthen quality practices while maintaining timeliness and accuracy in offshore operations.