Quality Specialist II

Premera Blue Cross; Salem (OR); Hybrid; USD 48,000 - 83,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

401K employer match

Pension plan

Tuition assistance

Commuter perks

On-site parking

Wellness resources

Job summary

Premera Blue Cross is seeking a quality auditor to perform audits across claims, enrollment, and customer service. You will develop audit plans, interpret standards, and report findings with actionable improvements.

The role emphasizes collaboration with multiple teams to strengthen quality controls. Ideal candidates bring a solid auditing background, troubleshooting skills, and the ability to communicate findings clearly.

Qualifications

• High school diploma or GED.
• Three years of claims, customer service or enrollment experience, including one year of quality audit/quality assurance.
• Bilingual proficiency (English/Spanish) preferred.
• Quality 101 certification preferred.

Responsibilities

• Conduct audits professionally and objectively using applicable standards.
• Plan, develop, and communicate audits within defined scope and resources.
• Maintain knowledge of audit techniques and reference materials.
• Verify, document, communicate audit results and evaluate corrective actions.
• Identify trends and root causes to recommend improvements.
• Collaborate with external departments to resolve high-impact issues.
• Lead and facilitate meetings related to quality review and reporting.

Skills

Auditing

Quality control

Communication

Bilingual English/Spanish

Education

High school diploma or GED

Job description

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.
• Partner across teams to drive quality improvements.
• Gain experience communicating audit findings and recommendations.

Physical Requirements:

The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: This is primarily a sedentary role, which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of rewards, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at or via phone at .

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin .

The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience.The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range: $48,400.00 - $72,600.00National Plus Salary Range: $55,200.00 - $82,800.00*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska .We're happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We're committed to creating an environment where all employees are celebrated for their unique skills and contributions.