Remote Quality Assurance Specialist II

Premera Blue Cross; Lake Michigan Beach (MI); Remote; USD 48,000 - 83,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

Pet insurance

Life and disability insurance

401K with employer match

Tuition assistance

Generous paid time off

Employee recognition program

Job summary

Premera Blue Cross is hiring a Quality Specialist II to oversee audits across claims processing, inquiries, enrollments, and electronic data exchanges. You will ensure compliance with BCBS MTM, LDLA, FEP, and corporate policies while partnering with stakeholders to drive quality improvements.

The role emphasizes analyzing performance, identifying long-term trends, and guiding corrective actions in a collaborative environment. A quality-focused mindset and strong documentation are essential.

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 assurance.
• May require bilingual proficiency (English/Spanish).
• Quality 101 certification is preferred.

Responsibilities

• Conduct audits professionally and objectively following standards.
• Plan, communicate, and scope audits with resource scheduling.
• Maintain knowledge of audit techniques and automated systems.
• Verify and report audit results and evaluate corrective actions.
• Identify trends and root causes to improve procedures.

Skills

Audit procedures

Quality assurance

Data analysis

Root cause analysis

Communication

Bilingual (English/Spanish)

Education

High school diploma or GED

Job description

Premera Blue Cross is hiring a Quality Specialist II to oversee audits across claims processing, inquiries, enrollments, and electronic data exchanges. You will ensure compliance with BCBS MTM, LDLA, FEP, and corporate policies while partnering with stakeholders to drive quality improvements.

The role emphasizes analyzing performance, identifying long-term trends, and guiding corrective actions in a collaborative environment. A quality-focused mindset and strong documentation are essential.