Quality Audit Specialist II (Remote)

Premera Blue Cross; Minneota (MN); Remote; USD 48,000 - 73,000; Full time

Benefits offered by this job

Commuter perks

On-site parking

Fitness & well-being center

Job summary

Premera Blue Cross is seeking a Quality Specialist II to join the Provider Contact Center Quality Program as a telecommuter. The role focuses on audits of claims processing, enrollments, and data exchanges to ensure compliance with BCBS A and FEP standards, state and federal laws, and corporate policies.

You will partner with stakeholders to identify opportunities for quality improvements, monitor standards, and lead discussions to resolve audit findings while supporting offshore operations and

Qualifications

• Three (3) years of claims, customer service or enrollment work experience, which includes one (1) year of quality audit, quality control, or quality assurance experience.
• May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately.
• Quality 101 certification.

Responsibilities

• Conduct audits professionally and objectively within scope.
• Plan, develop, and communicate an audit within defined scope and resources.
• Maintain knowledge of procedural changes and audit techniques.
• Verify, document, and communicate audit results and corrective actions.
• Resolve conflicts and discuss audit findings respectfully.
• Identify trends and root causes to improve procedures.
• Consult with external departments on quality issues.
• Lead and participate in team meetings regarding Quality Review & Reporting.
• Explain how audit function aligns with organizational goals.
• Perform other duties as assigned.

Skills

Quality audit

Claims processing

Customer service

Data analysis

Auditing techniques

Education

High school diploma or GED

Job description

Premera Blue Cross is seeking a Quality Specialist II to join the Provider Contact Center Quality Program as a telecommuter. The role focuses on audits of claims processing, enrollments, and data exchanges to ensure compliance with BCBS A and FEP standards, state and federal laws, and corporate policies.

You will partner with stakeholders to identify opportunities for quality improvements, monitor standards, and lead discussions to resolve audit findings while supporting offshore operations and