Remote Quality Assurance Auditor II – Healthcare

Premera Blue Cross; Seattle (WA); Remote; USD 48,000 - 73,000; Full time

Benefits offered by this job

Health insurance

401K

On-site parking

Tuition assistance

Job summary

Premera Blue Cross is seeking a Quality Specialist II to join the Provider Contact Center Quality Program. You will oversee audits of claims processing, enrollments, inquiries and electronic data exchanges, ensuring compliance with BCBS, FEP and corporate policies.

This role emphasizes quality improvement and collaboration across teams. The position requires 3 years in claims/quality roles, bilingual English/Spanish may be required, and a high school diploma.

Qualifications

• Three (3) years of claims, customer service or enrollment work experience, including one (1) year of quality audit, quality control, or quality assurance experience.
• Bilingual proficiency in English/Spanish may be required with clear communication.

Responsibilities

• Conduct audits in a professional, ethical and objective manner.
• Plan, develop, and communicate an audit within defined scope and resources.
• Maintain knowledge of audit techniques and applicable standards.
• Verify and communicate audit results; develop audit reports and corrective actions.
• Identify trends and root causes; recommend improved procedures.
• Consult with external departments to resolve quality issues.
• Lead and participate in team meetings on Quality Review & Reporting initiatives.
• Explain quality principles and align audit function with the organization.

Skills

Quality auditing

Claims processing

Customer service

Enrollment processing

Bilingual English/Spanish

Audit communication

Education

High school diploma or GED

Job description

Premera Blue Cross is seeking a Quality Specialist II to join the Provider Contact Center Quality Program. You will oversee audits of claims processing, enrollments, inquiries and electronic data exchanges, ensuring compliance with BCBS, FEP and corporate policies.

This role emphasizes quality improvement and collaboration across teams. The position requires 3 years in claims/quality roles, bilingual English/Spanish may be required, and a high school diploma.