Remote Quality Audit Specialist II

Premera Blue Cross; New Mexico; Remote; USD 48,000 - 83,000; Full time

Benefits offered by this job

Commuter perks

Free on-site parking

Tuition assistance (undergraduate &amp

Wellness programs

Job summary

Premera Blue Cross is seeking a Quality Specialist II in a remote capacity. You will oversee audits such as MTM, LDLA, and FEP, ensuring compliance with laws, contracts, and corporate objectives.

You’ll examine transactions like claims and enrollments, monitor quality standards, and work with stakeholders to drive improvements. The role requires a high school diploma or GED and 3 years in claims/customer service/enrollment with 1 year of quality assurance experience; bilingual proficiency

Qualifications

• High school diploma or GED is required.
• Three years of claims, customer service or enrollment work experience with one year in quality audit/quality assurance.
• Possible bilingual proficiency English/Spanish preferred.

Responsibilities

• Conduct audits professionally, ethically, and objectively.
• Plan and communicate audits within defined scope and schedule meetings.
• Maintain knowledge of audit procedures and automated systems.
• Utilize auditing tools; document results and evaluate corrective actions.
• Resolve conflicts respectfully and discuss audit findings.
• Identify error trends and recommend procedural improvements.
• Consult with external departments to resolve quality issues.
• Lead and facilitate team meetings on Quality Review & Reporting initiatives.
• Explain quality principles and align audit function to the organization.
• Other duties as assigned.

Skills

Quality auditing

Data analysis

Communication

Bilingual English/Spanish

Education

High school diploma or GED

Job description

Premera Blue Cross is seeking a Quality Specialist II in a remote capacity. You will oversee audits such as MTM, LDLA, and FEP, ensuring compliance with laws, contracts, and corporate objectives.

You’ll examine transactions like claims and enrollments, monitor quality standards, and work with stakeholders to drive improvements. The role requires a high school diploma or GED and 3 years in claims/customer service/enrollment with 1 year of quality assurance experience; bilingual proficiency