Remote Quality Assurance Auditor II - Healthcare

Premera Blue Cross; Arizona; Hybride; USD 48 000 - 83 000; Plein temps

Avantages offerts par ce poste

On-site parking

Commuter perks

On-site cafes

Fitness & well-being center

Résumé du poste

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our processes, including MTM, LDLA, and FEP audits, ensuring compliance with BCBS, state and federal requirements, and corporate policies. You will monitor quality across claims processing, inquiries, enrollments, and electronic data exchanges, partnering with stakeholders to drive improvements.

The role emphasizes planning and executing audits, analyzing trends, and guiding quality initiatives to enhance accuracy,

Qualifications

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

Responsabilités

• Conduct audits in a professional, ethical and objective manner using applicable standards/requirements.
• Plan, develop, and communicate an audit within a defined scope and schedule
• Maintain up-to-date knowledge of procedural changes, audit techniques, and reference materials for assigned audits.
• Utilize quality auditing tools and techniques; verify, document and communicate audit results; develop audit reports.
• Resolve conflicts respectfully and engage in conversations to resolve audit findings.
• Identify trends and root causes of errors; recommend improved procedures.
• Consult with external departments to address high-impact quality issues.
• Lead and participate in team meetings regarding Quality Review & Reporting initiatives.
• Explain the importance of aligning the audit function with organizational goals.
• Perform other duties as assigned.

Connaissances

Quality auditing

Bilingual English/Spanish

Customer service

Formation

High school diploma or GED

Description du poste

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our processes, including MTM, LDLA, and FEP audits, ensuring compliance with BCBS, state and federal requirements, and corporate policies. You will monitor quality across claims processing, inquiries, enrollments, and electronic data exchanges, partnering with stakeholders to drive improvements.

The role emphasizes planning and executing audits, analyzing trends, and guiding quality initiatives to enhance accuracy,