Remote Quality Audit Specialist II

Premera Blue Cross; Nashville (TN); Remoto; USD 60.000 - 78.000; Tempo integral

Resumo da vaga

Premera Blue Cross is seeking a Quality Auditor to conduct audits of claims, enrollment, and customer-service processes. The role emphasizes ethical, objective review and adherence to standards to improve quality and reduce risk.

You will plan audits, document findings, and partner with departments to resolve issues, while building expertise in quality assurance and data analysis across the organization.

Qualificações

• 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.
• May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately.
• Quality 101 certification.

Responsabilidades

• Conduct audits in a professional, ethical and objective manner using and interpreting applicable standards/requirements.
• Plan, develop, and communicate an audit within a defined scope, including resource scheduling. Conduct necessary meetings in performance of the audit.
• 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.

Conhecimentos

Claims experience

Customer service

Enrollment

Quality audit

Quality control

Quality assurance

Formação

High school diploma or GED

Descrição da vaga

Premera Blue Cross is seeking a Quality Auditor to conduct audits of claims, enrollment, and customer-service processes. The role emphasizes ethical, objective review and adherence to standards to improve quality and reduce risk.

You will plan audits, document findings, and partner with departments to resolve issues, while building expertise in quality assurance and data analysis across the organization.