Remote Quality Audit Specialist II

Premera Blue Cross; Central City (KY); Remote; USD 48,000 - 83,000; Full time

Job summary

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our provider and claims processes in a telecommuter role. You’ll partner with stakeholders to identify opportunities for quality improvement and ensure compliance with MTM, LDLA, and FEP audit requirements.

You will monitor audit results, develop reports, and guide corrective actions while promoting a culture of accuracy, timeliness, and customer care across Premera’s offshore operations and state/federal regulations.

Qualifications

• High school diploma or GED. (Required)
• Three (3) years of claims, customer service or enrollment work experience, which includes one (1) year of quality audit, quality control, or quality assurance experience. (Required)
• May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately. (Preferred)
• Quality 101 certification. (Preferred)

Responsibilities

• Conduct audits in a professional, ethical and objective manner.
• Plan, develop, and communicate audits within a defined scope.
• Maintain in-depth working knowledge of procedural changes, audit techniques, and plan automated systems, subsystems, and reference materials for assigned audit functions.
• Responsible for a wide variety of quality auditing tools and techniques. Verify, document and communicate audit results, develop an audit report, and evaluate the effectiveness of corrective action/follow-up.
• Resolve conflict directly and respectfully, engaging in challenging and important conversations to resolve audit findings.
• Identify trends and the root cause of errors and recommend improved procedures/guidelines to Operations proactively.
• Assist in consulting with external departments to help resolve high impact key business issues surrounding quality assurance.
• Help individuals and the team become stronger by actively participating, leading and facilitating team meetings and work groups regarding Quality Review & Reporting initiatives and incentives.
• Understand quality principles as they relate to business processes and explain the importance of aligning the audit function to the organization.
• Other duties as assigned.

Skills

Quality auditing

Quality control

Bilingual (English/Spanish)

Education

High school diploma or GED

Quality 101 certification

Job description

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our provider and claims processes in a telecommuter role. You’ll partner with stakeholders to identify opportunities for quality improvement and ensure compliance with MTM, LDLA, and FEP audit requirements.

You will monitor audit results, develop reports, and guide corrective actions while promoting a culture of accuracy, timeliness, and customer care across Premera’s offshore operations and state/federal regulations.