Quality Assurance Specialist II - Healthcare Compliance

Premera Blue Cross; Missouri; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, vision, dental coverage

Life and disability insurance

401K employer match and pension plan

Tuition assistance

On-site resources and hybrid model

Job summary

Premera Blue Cross in the United States is seeking a Quality Specialist II for the Provider Contact Center Quality Program, including offshore operations. You will oversee compliance with MTM, LDLA, and FEP audits, and verify daily transactions such as claims processing and member enrollment.

You will partner with stakeholders to identify opportunities for quality improvement, monitor standards for accuracy and timeliness, and lead meetings to share findings and drive corrective actions.

Qualifications

• Three years of claims, customer service or enrollment work experience, including one year in quality audit/quality assurance.
• Strong data analysis and root-cause problem-solving skills.
• Ability to communicate clearly in person or over the phone.

Responsibilities

• Oversee compliance with audit programs (MTM, LDLA, FEP).
• Verify and audit Premera transactions (claims, enrollments, inquiries).
• Monitor quality standards for accuracy, completeness and timeliness.
• Identify trends and drive corrective actions with Operations.
• Lead and participate in meetings to share quality results and improvements.
• Partner with cross-functional teams to implement quality improvements.
• Ensure adherence to state and federal laws and corporate policies.

Skills

Quality auditing

Quality assurance

Claims processing

Customer service

Bilingual English/Spanish

Education

High school diploma or GED

Job description

Premera Blue Cross in the United States is seeking a Quality Specialist II for the Provider Contact Center Quality Program, including offshore operations. You will oversee compliance with MTM, LDLA, and FEP audits, and verify daily transactions such as claims processing and member enrollment.

You will partner with stakeholders to identify opportunities for quality improvement, monitor standards for accuracy and timeliness, and lead meetings to share findings and drive corrective actions.