Quality Specialist II
About The Position
The Quality Specialist II joins Premera’s Provider Contact Center Quality Program and helps improve quality across offshore operations. The role oversees compliance with corporate audit programs, including the Blue Cross Blue Shield Association (BCBSA) Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and Federal Employee Program (FEP) audits, as well as applicable state and federal laws, contracts, and corporate objectives. The position examines and verifies Premera transactions, including claims processing, customer inquiries, group and member enrollment, and electronic data exchange. It monitors selected transactions for accuracy, completeness, timeliness, and adherence to applicable BCBSA, FEP, and corporate policy criteria. The Quality Specialist II partners with stakeholders to identify improvement opportunities, communicate audit findings, and support quality improvements throughout the company.
Requirements
- High school diploma or GED.
- Three years of claims, customer service, or enrollment work experience, including one year of quality audit, quality control, or quality assurance experience.
Nice To Haves
- Bilingual proficiency in a particular language, potentially English/Spanish, with the ability to communicate messages and information clearly and accurately.
- Quality 101 certification.
Responsibilities
- Conduct audits professionally, ethically, and objectively, applying and interpreting relevant standards and requirements.
- Plan, develop, and communicate audits within a defined scope, including scheduling resources and conducting necessary meetings.
- Maintain working knowledge of procedural changes, audit techniques, plan automated systems and subsystems, and reference materials for assigned audit functions.
- Use quality auditing tools and techniques to verify, document, and communicate results; develop audit reports; and evaluate corrective actions and follow-up.
- Address conflicts directly and respectfully and engage in challenging conversations to resolve audit findings.
- Identify error trends and root causes, and proactively recommend improved procedures and guidelines to Operations.
- Consult with external departments to help resolve high-impact business issues related to quality assurance.
- Participate in, lead, and facilitate team meetings and work groups concerning Quality Review & Reporting initiatives and incentives.
- Apply and explain quality principles as they relate to business processes and align the audit function with organizational needs.
- Perform other duties as assigned.
Benefits
- Medical, vision, and dental coverage with low employee premiums.
- Voluntary benefits, including pet insurance.
- Life and disability insurance.
- Retirement programs, including a 401(k) employer match and a pension plan vested after three years of service.
- Wellness incentives and mental well-being resources, including counseling, stress management, and mindfulness programs.
- Generous paid time off.
- Tuition assistance for undergraduate and graduate degrees.
- Employee recognition program.
- Commuter perks.
- Free on-site parking.
- Subsidized on-campus cafes.
- On-site activities, including health and wellness events, coffee connects, and disaster preparedness fairs.
- Fitness and well-being center with in-person and virtual workouts and nutritional counseling.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
