Quality Assurance Specialist II – Healthcare Compliance & Audit

Premera Blue Cross; Salem (NH); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical insurance

401(k) with match

Pension plan

Tuition assistance

On-site parking

Hybrid work model

Job summary

Premera Blue Cross in Salem, NH seeks a Quality Specialist II for the Provider Contact Center Quality Program. You will oversee audits such as MTM, LDLA, and FEP, ensuring accuracy across claims, enrollments, and inquiries.

You will partner with stakeholders to drive quality improvements and compliance with state, federal laws, contracts, and corporate policies. Ideal candidates have a high school diploma or GED with 3 years in claims/customer service/enrollment and at least 1 year in quality

Qualifications

• High school diploma or GED with 3 years of claims/customer service/enrollment experience, including 1 year of quality audit/quality assurance experience.
• May require bilingual proficiency (English/Spanish) to articulate messages clearly.
• Quality 101 certification and building expertise in quality auditing and compliance standards.

Responsibilities

• Maintain in-depth knowledge of procedural changes, audit techniques, and plan automated systems.
• Verify, document, communicate audit results, develop audit reports, and evaluate corrective actions.
• Identify trends and root causes; recommend improved procedures.
• Consult with external departments to resolve high impact quality issues.
• Lead and facilitate quality review, reporting initiatives, and team meetings.

Skills

Quality auditing

Data analysis

Bilingual English/Spanish

Education

High school diploma or GED

Quality 101 certification

Job description

Premera Blue Cross in Salem, NH seeks a Quality Specialist II for the Provider Contact Center Quality Program. You will oversee audits such as MTM, LDLA, and FEP, ensuring accuracy across claims, enrollments, and inquiries.

You will partner with stakeholders to drive quality improvements and compliance with state, federal laws, contracts, and corporate policies. Ideal candidates have a high school diploma or GED with 3 years in claims/customer service/enrollment and at least 1 year in quality