Remote Quality Auditor II – Healthcare Compliance

Premera Blue Cross; Tennessee; Hybrid; USD 48,000 - 83,000; Full time

Benefits offered by this job

On-site parking

Commuter perks

On-site cafes

Wellness center

Job summary

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across offshore operations and support compliance with MTM, LDLA, FEP, and related corporate policies. The role emphasizes examining claims processing, member enrollment, and data exchange to ensure accuracy, timeliness, and adherence to standards.

You will collaborate with stakeholders to identify opportunities for quality improvement, strengthen quality practices, and drive meaningful improvements across the organization.

Qualifications

• High school diploma or GED required.
• Minimum 3 years in claims, customer service or enrollment with at least 1 year in quality audit/QA.
• Bilingual English/Spanish ability possibly preferred.
• Quality 101 certification preferred.

Responsibilities

• Conduct audits in a professional, ethical and objective manner.
• Plan, develop, and communicate an audit within a defined scope.
• Maintain knowledge of procedural changes and audit techniques.
• Utilize quality auditing tools; verify and report audit results.
• Resolve audit findings through constructive dialogue.
• Identify trends and root causes; recommend improvements.
• Consult with external departments to resolve quality issues.
• Lead and facilitate team meetings on Quality Review & Reporting.
• Explain quality principles and align audit function to the organization.
• Perform other duties as assigned.

Education

High school diploma or GED

Job description

Premera Blue Cross is seeking a Quality Specialist II to oversee audits across offshore operations and support compliance with MTM, LDLA, FEP, and related corporate policies. The role emphasizes examining claims processing, member enrollment, and data exchange to ensure accuracy, timeliness, and adherence to standards.

You will collaborate with stakeholders to identify opportunities for quality improvement, strengthen quality practices, and drive meaningful improvements across the organization.