Remote Quality Auditor II – Healthcare Compliance

Premera Blue Cross; Minnesota; Hybride; USD 48 000 - 73 000; Plein temps

Avantages offerts par ce poste

Medical, vision & dental coverage

Pet insurance

Life & disability insurance

401K with employer match + pension

Résumé du poste

Premera Blue Cross in United States (Minnesota previously stated) seeks a Quality Specialist II to oversee audits of claims processing, enrollment and electronic transactions. You will monitor quality standards, coordinate with BCBS associations and FEP audits, and drive continuous improvements across offshore operations.

The role emphasizes collaboration with stakeholders to identify opportunities for quality improvement and ensure adherence to state and federal regulations and corporate

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 assurance (Required).
• Bilingual proficiency in English/Spanish with clear communication (Preferred).
• Quality 101 certification (Preferred).

Responsabilités

• Conduct audits in a professional, ethical and objective manner per applicable standards.
• Plan, communicate and scope audits, including resource scheduling.
• Maintain knowledge of audit techniques and automated systems for assigned functions.
• Verify, document and communicate audit results and develop audit reports.
• Resolve audit findings through constructive dialogue with stakeholders.
• Identify trends and root causes; recommend improved procedures.
• Consult with external departments to resolve quality issues.
• Lead and facilitate team meetings on Quality Review & Reporting initiatives.
• Explain quality principles and align auditing with organizational goals.
• Perform other duties as assigned.

Connaissances

Quality audits

Customer service

Bilingual English/Spanish (Preferred)

Formation

High school diploma or GED

Description du poste

Premera Blue Cross in United States (Minnesota previously stated) seeks a Quality Specialist II to oversee audits of claims processing, enrollment and electronic transactions. You will monitor quality standards, coordinate with BCBS associations and FEP audits, and drive continuous improvements across offshore operations.

The role emphasizes collaboration with stakeholders to identify opportunities for quality improvement and ensure adherence to state and federal regulations and corporate