Remote Quality Specialist II – Audit & Compliance

Premera Blue Cross; South Dakota; Remoto; USD 48.000 - 83.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, vision, dental coverage

401K with employer match

Paid time off

Tuition assistance

Descrizione del lavoro

Premera Blue Cross is seeking a Quality Specialist II to oversee audits of claims processing, inquiries, enrollments and electronic transactions, ensuring compliance with BCBA, FEP, and corporate policies. This telecommuter role collaborates with stakeholders to identify opportunities for quality improvements.

You will conduct audits, document results, report findings, and support root-cause analysis. A high school diploma and 3 years of claims/customer service experience (including quality

Competenze

• High school diploma or GED required.
• Three years of claims, customer service or enrollment work experience including one year of quality audit/quality assurance.
• Bilingual ability (English/Spanish) preferred.

Mansioni

• Conduct audits in a professional, ethical, objective manner per standards.
• Plan and communicate audits within defined scope and schedule necessary meetings.
• Maintain knowledge of audit techniques and reference materials for assigned functions.
• Verify, document and communicate audit results; develop reports and evaluate corrective actions.
• Identify audit findings and recommend improved procedures to Operations.
• Collaborate with external departments to resolve high-impact quality issues.

Conoscenze

Quality auditing

Claims processing knowledge

Bilingual English/Spanish

Formazione

High school diploma or GED

Descrizione del lavoro

Premera Blue Cross is seeking a Quality Specialist II to oversee audits of claims processing, inquiries, enrollments and electronic transactions, ensuring compliance with BCBA, FEP, and corporate policies. This telecommuter role collaborates with stakeholders to identify opportunities for quality improvements.

You will conduct audits, document results, report findings, and support root-cause analysis. A high school diploma and 3 years of claims/customer service experience (including quality