Quality Specialist II

Premera Blue Cross; Lansing (MI); A distancia; USD 50.000 - 65.000; Jornada completa

Descripción de la vacante

Premera Blue Cross is seeking a quality auditor to work remotely, focusing on audits of claims, enrollment, and customer service processes. You will plan and conduct audits, document results, and help drive quality improvements across departments.

The role requires a high school diploma or GED and at least three years in claims, customer service, or enrollment, with one year in quality audit or assurance. Bilingual ability may be preferred.

Formación

• High school diploma or GED required.
• Three years of claims, customer service or enrollment work experience, including one year of quality audit/quality assurance.
• Bilingual English/Spanish ability may be preferred.

Responsabilidades

• Conduct audits professionally, ethically, and objectively using applicable standards.
• Plan, develop, and communicate an audit within a defined scope and schedule meetings.
• Maintain knowledge of procedural changes, audit techniques, and reference materials.
• Use auditing tools to verify, document, communicate results, and evaluate corrective actions.
• Resolve conflicts respectfully and discuss audit findings with stakeholders.
• Identify trends and root causes; suggest improved procedures.
• Consult with external departments to resolve quality issues.
• Lead and participate in team meetings focused on Quality Review & Reporting.
• Explain quality principles and align audit function with the organization.
• Perform other duties as assigned.

Conocimientos

Quality auditing

Claims/customer service experience

Quality assurance experience

Educación

High school diploma or GED

Descripción del empleo

Workforce Classification: TelecommuterJoin Our Team: Do Meaningful Work and Improve People's LivesOur purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we're able to better serve our customers. It's this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: .

What you will do:

• Conduct audits in a professional, ethical and objective manner using and interpreting applicable standards/requirements.
• Effectively plan, develop, and communicate an audit within a defined scope, including resource scheduling. Conduct necessary meetings in performance of the audit.
• Maintain in-depth working knowledge of procedural changes, audit techniques, and plan automated systems, subsystems, and reference materials for assigned audit functions.
• Responsible for a wide variety of quality auditing tools and techniques. Verify, document and communicate audit results, develop an audit report, and evaluate the effectiveness of corrective action/follow-up.
• Resolve conflict directly and respectfully, engaging in challenging and important conversations to resolve audit findings.
• Identify trends and the root cause of errors and recommend improved procedures/guidelines to Operations proactively.
• Assist in consulting with external departments to help resolve high impact key 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.
• Other duties as assigned.

What you will bring:

• High school diploma or GED. (Required)
• 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. (Required)
• May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately. (Preferred)
• Quality 101 certification. (Preferred)

What you will gain:

• Build expertise in quality auditing and compliance standards.
• Strengthen data analysis and root-cause problem-solving skills.inuation