Remote Quality Assurance Auditor II

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

Job summary

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our offshore operations and ensure compliance with MTM, LDLA, FEP, and corporate policies. You will examine transactions, claims, enrollments, and inquiries for timeliness, accuracy, and completeness, partnering with stakeholders to drive quality improvements.

The role requires a high school diploma, 3 years of claims/enrollment experience with 1 year in quality assurance, and preferred bilingual skills and Quality

Qualifications

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

Responsibilities

• Conduct audits in a professional, ethical and objective manner using applicable standards.
• Plan, develop, and communicate an audit within a defined scope and schedule
• Maintain knowledge of procedural changes, audit techniques, and automated systems relevant to audits.
• Verify, document and communicate audit results; develop audit reports and follow-up on corrective actions.
• Resolve conflicts respectfully and address audit findings.
• Identify trends and root causes and recommend improved procedures.
• Consult with external departments to resolve high-impact quality issues.
• Lead and participate in team meetings and quality initiatives.
• Explain quality principles and align audit activities with organizational goals.
• Perform other duties as assigned.

Skills

Claims/enrollment experience

Quality audit/QA experience

Bilingual (English/Spanish)

Education

High school diploma or GED

Quality 101 certification (preferred)

Job description

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our offshore operations and ensure compliance with MTM, LDLA, FEP, and corporate policies. You will examine transactions, claims, enrollments, and inquiries for timeliness, accuracy, and completeness, partnering with stakeholders to drive quality improvements.

The role requires a high school diploma, 3 years of claims/enrollment experience with 1 year in quality assurance, and preferred bilingual skills and Quality