Remote Quality Assurance Auditor II

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

Benefits offered by this job

Hybrid on-site resources

Commuter perks

Free on-site parking

Subsidized on-campus cafes

Fitness & well-being center

Job summary

Premera Blue Cross in Michigan is seeking a Quality Specialist II to support offshore operations by auditing claims, enrollments, inquiries, and electronic transactions for accuracy and timeliness.

You will partner with stakeholders to identify quality improvements, ensure compliance with BCBS MTM, LDLA, and FEP audits, and help the team raise performance through data analysis and clear reporting.

Qualifications

• High school diploma or GED (Required).
• Three (3) years of claims, customer service or enrollment work experience, including one (1) year of quality audit/quality assurance (Required).
• May require bilingual proficiency in English/Spanish; Preferred.
• Quality 101 certification (Preferred).

Responsibilities

• Conduct audits in a professional, ethical and objective manner.
• Plan, develop, and communicate an audit within a defined scope, including resource scheduling.
• Maintain knowledge of procedural changes, audit techniques, and systems for audits.
• Verify, document and communicate audit results; develop an audit report.
• Resolve conflicts with stakeholders to address audit findings.
• Identify trends and root causes; recommend improved procedures.
• Consult with external departments to resolve quality issues.
• Lead and facilitate team meetings on Quality Review & Reporting initiatives.
• Explain quality principles and alignment of audit function to the organization.
• Other duties as assigned.

Skills

Claims processing

Quality auditing

Customer service

Enrollment processing

Education

High school diploma or GED

Quality 101 certification

Job description

Premera Blue Cross in Michigan is seeking a Quality Specialist II to support offshore operations by auditing claims, enrollments, inquiries, and electronic transactions for accuracy and timeliness.

You will partner with stakeholders to identify quality improvements, ensure compliance with BCBS MTM, LDLA, and FEP audits, and help the team raise performance through data analysis and clear reporting.