Remote Quality Auditor II - Healthcare Compliance

Premera Blue Cross; Maine; Remoto; USD 48.000 - 83.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Vision coverage

Dental coverage

401K match

Pension plan

Wellness program

Tuition assistance

Paid time off

On-site parking

Descrizione del lavoro

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across multiple programs, including MTM, LDLA, and FEP, ensuring compliance with state and federal laws and corporate policies. You will examine claims, inquiries, enrollments, and electronic exchanges daily to measure adherence to standards and drive improvements.

The role partners with stakeholders to identify opportunities for quality improvement and to strengthen quality practices across offshore operations and the

Competenze

• 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.
• Quality 101 certification (Preferred).

Mansioni

• Conduct audits in a professional, ethical and objective manner using and interpreting applicable standards/requirements.
• Plan and communicate an audit scope, including resource scheduling and meetings.
• Maintain knowledge of procedural changes and audit techniques; plan automated systems and references.
• Verify, document and communicate audit results; develop audit reports and corrective actions.
• Identify trends and root causes to recommend improved procedures.
• Consult with external departments to resolve high impact quality issues.
• Lead and facilitate team meetings on Quality Review & Reporting initiatives.
• Explain the importance of aligning audit functions to the organization.

Conoscenze

Quality auditing

Claims experience

Customer service

Enrollment

Bilingual (English/Spanish)

Formazione

High school diploma

Strumenti

Audit tools

Descrizione del lavoro

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across multiple programs, including MTM, LDLA, and FEP, ensuring compliance with state and federal laws and corporate policies. You will examine claims, inquiries, enrollments, and electronic exchanges daily to measure adherence to standards and drive improvements.

The role partners with stakeholders to identify opportunities for quality improvement and to strengthen quality practices across offshore operations and the