Remote Product & Group Configuration Quality Analyst II

Premera Blue Cross; United States; Remote; USD 48,000 - 83,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

401(k) match

Pension plan

Tuition assistance

Paid time off

Job summary

Premera Blue Cross seeks a skilled Quality Specialist II to audit and validate medical, dental, and pharmacy product configurations for members across the US. The role emphasizes accuracy, feedback, and continuous improvement in a telecommuting environment.

You will review configurations against source documentation, document findings, and support training to reduce recurring issues while aligning with established standards and downstream processes.

Qualifications

• High school diploma or GED (Required).
• Two (2) years of work experience in claims, customer service, membership and billing, product configuration, quality, or auditing (Required).
• One (1) year of auditing experience, such as quality review, configuration audit, operational audit, or comparable experience.
• SQL experience.
• Healthcare experience.
• Experience providing effective, constructive feedback to peers or partners to drive corrections and learning.
• Exposure to health insurance products and benefit terminology, including Medical, RX, and Dental, in a configuration, operations, or service environment.

Responsibilities

• Perform audits and testing of standard medical, dental, and pharmacy configuration work, including shells and entry-level final configurations, to verify alignment with source documentation and established processes.
• Analyze configuration outputs to confirm accuracy, completeness, and consistency prior to downstream processing.
• Deliver clear documentation of audit findings and required corrections to configuration partners.
• Support quality outcomes by providing timely, respectful, and actionable feedback that enables correction and learning.
• Analyze recurring issues and error patterns to identify trends that support training and process improvement.
• Maintain knowledge of audit procedures, configuration standards, mandates, and reference materials to ensure consistent application during audits.
• Participate in calibration discussions and quality reviews to promote consistent audit interpretation and outcomes.
• Support project work and related efforts aligned to team priorities.
• Other duties as assigned.

Tools

SQL

Job description

Premera Blue Cross seeks a skilled Quality Specialist II to audit and validate medical, dental, and pharmacy product configurations for members across the US. The role emphasizes accuracy, feedback, and continuous improvement in a telecommuting environment.

You will review configurations against source documentation, document findings, and support training to reduce recurring issues while aligning with established standards and downstream processes.