Remote Quality Assurance Specialist II

Premera Blue Cross; Accident (MD); Remoto; USD 48.000 - 83.000; Tempo pieno

Vantaggi offerti da questo lavoro

Commuter perks

Free on-site parking

Campus cafes

Fitness & well-being center

Descrizione del lavoro

Premera Blue Cross is hiring for a Quality Specialist II in our Provider Contact Center Quality Program. This remote role focuses on auditing claims, enrollments, and inquiries to ensure compliance with BCBA and FEP standards, driving improvements across offshore operations.

You will partner with stakeholders to identify opportunities for quality improvement, monitor performance, and report findings. A high school diploma is required, with 3 years of claims/customer experience and 1 year in

Competenze

• 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 preferred with ability to articulate messages clearly.
• Quality 101 certification preferred.

Mansioni

• Conduct audits in a professional, ethical and objective manner using applicable standards/requirements.
• Plan, develop, and communicate audits within a defined scope and resource schedule.
• Maintain knowledge of procedural changes, audit techniques, and reference materials for audit functions.
• Verify, document and communicate audit results; develop audit reports and evaluate corrective actions.
• Resolve audit findings through direct, respectful communication and root-cause analysis.
• Identify trends and root causes to propose improved procedures to Operations.
• Consult with external departments to resolve high impact quality issues.
• Lead team meetings and participate in Quality Review & Reporting initiatives.

Conoscenze

Quality audit experience

Customer service

Bilingual English/Spanish

Formazione

High school diploma or GED

Descrizione del lavoro

Premera Blue Cross is hiring for a Quality Specialist II in our Provider Contact Center Quality Program. This remote role focuses on auditing claims, enrollments, and inquiries to ensure compliance with BCBA and FEP standards, driving improvements across offshore operations.

You will partner with stakeholders to identify opportunities for quality improvement, monitor performance, and report findings. A high school diploma is required, with 3 years of claims/customer experience and 1 year in