Remote Quality Auditor II – Healthcare Compliance

Premera Blue Cross; Madison (WI); Remote; USD 52,000 - 76,000; Full time

Job summary

Premera Blue Cross is seeking a Quality Auditor to ensure compliance and improve processes across claims, enrollment, and customer service. You will conduct audits, document findings, and drive corrective actions with cross-functional teams.

You should have a high school diploma, 3 years in relevant work experience (with at least 1 year in quality assurance). Quality 101 certification is preferred, and bilingual ability is a plus.

Qualifications

• Three years of claims, customer service or enrollment work experience, including one year in quality audit, quality control or quality assurance.
• High school diploma or GED required.
• Bilingual proficiency (English/Spanish) may be preferred with clear communication.
• Quality 101 certification preferred.

Responsibilities

• Conduct audits professionally and objectively using applicable standards.
• Plan, develop, and communicate audits within defined scope and resources.
• Maintain knowledge of audit techniques and related systems.
• Verify, document, and communicate audit results and corrective actions.
• Identify trends and root causes to recommend improvements.
• Collaborate with external departments on high-impact issues.
• Lead and facilitate team meetings on Quality Review & Reporting initiatives.
• Explain quality principles and align audit functions with the organization.
• Perform other duties as assigned.

Skills

Quality auditing

Data analysis

Root cause analysis

Bilingual English/Spanish (preferred)

Education

High school diploma or GED

Tools

Quality tools

Job description

Premera Blue Cross is seeking a Quality Auditor to ensure compliance and improve processes across claims, enrollment, and customer service. You will conduct audits, document findings, and drive corrective actions with cross-functional teams.

You should have a high school diploma, 3 years in relevant work experience (with at least 1 year in quality assurance). Quality 101 certification is preferred, and bilingual ability is a plus.