Remote Quality Auditor II – Healthcare Compliance

Premera Blue Cross; South Carolina; Remote; USD 48,000 - 73,000; Full time

Benefits offered by this job

Medical vision dental coverage

401K employer match

Pension plan

Job summary

Premera Blue Cross is seeking a Quality Specialist II for its offshore operations within the Provider Contact Center Quality Program. You will oversee audits of claims processing, inquiries, enrollments, and electronic data exchanges, ensuring compliance with BCBS standards and federal/state requirements.

This role emphasizes quality improvement across the organization and collaboration with stakeholders. The position requires a high school diploma or GED and 3 years in related fields, with 1

Qualifications

• High school diploma or GED required.
• Three years of claims, customer service or enrollment experience, including one year of quality audit, quality control, or quality assurance experience.
• May require bilingual proficiency in English/Spanish; preferred.
• Quality 101 certification preferred.

Responsibilities

• Conduct audits professionally and objectively using applicable standards.
• Plan, communicate, and document audits within defined scope and resources.
• Maintain knowledge of audit changes and plan automated systems for audits.
• Verify results, prepare audit reports, and evaluate corrective actions.
• Identify root causes and contribute to improved procedures.
• Collaborate with other departments to resolve quality issues.

Skills

Quality auditing

Data analysis

Audit reporting

Education

High school diploma or GED

Job description

Premera Blue Cross is seeking a Quality Specialist II for its offshore operations within the Provider Contact Center Quality Program. You will oversee audits of claims processing, inquiries, enrollments, and electronic data exchanges, ensuring compliance with BCBS standards and federal/state requirements.

This role emphasizes quality improvement across the organization and collaboration with stakeholders. The position requires a high school diploma or GED and 3 years in related fields, with 1