Remote Quality Auditor II - Healthcare Compliance

Premera Blue Cross; Bozeman (MT); À distance; USD 48 000 - 73 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

401K match

Pension plan

Tuition assistance

Wellness programs

Paid time off

Résumé du poste

Premera Blue Cross is seeking a Quality Specialist II to join the Provider Contact Center Quality Program and help shape quality across our offshore operations. The role ensures compliance with audits like MTM, LDLA, and FEP, and reviews claims processing, customer inquiries, enrollments, and EDI transactions to drive continual quality improvements.

The position requires a high school diploma, 3 years in claims/customer service/enrollment with 1 year in quality audit/quality assurance, and

Qualifications

• High school diploma or GED.
• 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.

Responsabilités

• 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.

Formation

High school diploma or GED

Description du poste

Premera Blue Cross is seeking a Quality Specialist II to join the Provider Contact Center Quality Program and help shape quality across our offshore operations. The role ensures compliance with audits like MTM, LDLA, and FEP, and reviews claims processing, customer inquiries, enrollments, and EDI transactions to drive continual quality improvements.

The position requires a high school diploma, 3 years in claims/customer service/enrollment with 1 year in quality audit/quality assurance, and