Remote Quality Auditor II - Healthcare Compliance

Premera Blue Cross; Clayton (NM); Remote; USD 48,000 - 83,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

Commuter perks

Free on-site parking

Job summary

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our provider contact center offshore operations. You will partner with teams to identify opportunities, strengthen quality practices, and drive improvements that measurably impact accuracy, timeliness, and customer satisfaction.

The role requires a high school diploma, 3 years in claims or enrollment with a year in quality auditing, and preferred bilingual ability (English/Spanish).

Qualifications

• High school diploma or GED required.
• Three (3) years of claims, customer service or enrollment work experience, including one (1) year of quality audit, quality control, or quality assurance experience.
• May require bilingual proficiency (English/Spanish) with clear articulation (preferred). Quality 101 certification (preferred).

Responsibilities

• Conduct audits professionally and objectively using applicable standards/requirements.
• Plan, develop, and communicate audits within defined scope and resources.
• Maintain knowledge of procedural changes, audit techniques, and reference materials.
• Verify, document, and communicate audit results; develop audit reports and corrective actions.
• Resolve conflicts directly and respectfully during audit findings discussions.
• Identify trends and root causes; recommend improved procedures.
• Consult with external departments to resolve high-impact business issues around quality assurance.
• Lead and participate in meetings and work groups on Quality Review & Reporting initiatives and incentives.

Skills

Quality auditing

Bilingual (English/Spanish)

Communication

Education

High school diploma or GED

Job description

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across our provider contact center offshore operations. You will partner with teams to identify opportunities, strengthen quality practices, and drive improvements that measurably impact accuracy, timeliness, and customer satisfaction.

The role requires a high school diploma, 3 years in claims or enrollment with a year in quality auditing, and preferred bilingual ability (English/Spanish).