Quality Assurance Specialist II – Healthcare Audit & Compliance

Premera Blue Cross; Texas; Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical coverage

Vision coverage

Dental coverage

Life insurance

Disability insurance

401K with match

Tuition assistance

Hybrid work model

On-site parking

Wellness center

Job summary

Premera seeks a Quality Specialist II to oversee audits across our offshore operations, ensuring compliance with MTM, LDLA, and FEP audits and state and federal requirements. You will identify opportunities for quality improvements and partner with stakeholders to implement corrective actions.

The role involves daily examination of claims, inquiries, enrollments, and electronic data exchange, with a focus on accuracy and timeliness.

Qualifications

• High school diploma or GED and 3 years of claims, customer service or enrollment experience, including 1 year in quality audit.
• May require bilingual proficiency in English/Spanish with clear communication.
• Quality 101 certification and build expertise in auditing and compliance standards.
• Strengthen data analysis and root-cause problem-solving skills.
• Partner across teams to drive quality improvements.
• Essential physical requirements include keyboard use and clear verbal communication.

Responsibilities

• Maintain in-depth knowledge of procedural changes, audit techniques, and plan automated systems.
• Verify, document and communicate audit results; develop an audit report and follow-up actions.
• Identify trends and root causes; recommend improved procedures to Operations.
• Consult with external departments to resolve high-impact 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.
• Conduct daily examination of transactions such as claims, inquiries, enrollments and electronic data exchange.
• Perform meetings in performance of the audit.

Skills

Quality auditing

Data analysis

Root cause analysis

Cross-team collaboration

Bilingual English/Spanish

Education

High school diploma or GED

Quality 101 certification

Tools

Audit software

Job description

Premera seeks a Quality Specialist II to oversee audits across our offshore operations, ensuring compliance with MTM, LDLA, and FEP audits and state and federal requirements. You will identify opportunities for quality improvements and partner with stakeholders to implement corrective actions.

The role involves daily examination of claims, inquiries, enrollments, and electronic data exchange, with a focus on accuracy and timeliness.