Remote Quality Audit Specialist II

Premera Blue Cross; Idaho Falls (ID); Remote; USD 60,000 - 85,000; Full time

Job summary

Premera Blue Cross in the United States is seeking a quality auditor to conduct audits, plan scopes, and communicate results within defined parameters. This telecommuter role lets you contribute to healthcare quality while collaborating with cross-functional teams across Operations and Compliance.

You will maintain current knowledge of auditing standards, analyze data to uncover root causes, and recommend procedural improvements.

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 professionally and objectively using applicable standards.
• Plan, develop, and communicate audits within a defined scope, including resource scheduling.
• 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

Auditing

Data analysis

Quality assurance

Root cause analysis

Communication

Bilingual English/Spanish

Education

High school diploma or GED

Job description

Premera Blue Cross in the United States is seeking a quality auditor to conduct audits, plan scopes, and communicate results within defined parameters. This telecommuter role lets you contribute to healthcare quality while collaborating with cross-functional teams across Operations and Compliance.

You will maintain current knowledge of auditing standards, analyze data to uncover root causes, and recommend procedural improvements.