Quality Specialist II

Premera Blue Cross is hiring a Quality Specialist II for its Provider Contact Center Quality Program. The role oversees audit and regulatory compliance, examines healthcare transactions for quality, and partners with stakeholders to identify and drive improvements.

Responsibilities

• Conduct audits in a professional, ethical and objective manner using and interpreting applicable standards/requirements
• Effectively plan, develop, and communicate an audit within a defined scope, including resource scheduling. Conduct necessary meetings in performance of the audit
• Maintain in-depth working knowledge of procedural changes, audit techniques, and plan automated systems, subsystems, and reference materials for assigned audit functions
• Responsible for a wide variety of quality auditing tools and techniques. Verify, document and communicate audit results, develop an audit report, and evaluate the effectiveness of corrective action/follow-up
• Resolve conflict directly and respectfully, engaging in challenging and important conversations to resolve audit findings
• Identify trends and the root cause of errors and recommend improved procedures/guidelines to Operations proactively
• Assist in consulting with external departments to help resolve high impact key business issues surrounding quality assurance
• Help individuals and the team become stronger by actively participating, leading and facilitating team meetings and work groups regarding Quality Review & Reporting initiatives and incentives
• Understand quality principles as they relate to business processes and explain the importance of aligning the audit function to the organization
• Other duties as assigned

Preferred

• May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately
• Quality 101 certification
• Bilingual English-Spanish
• Quality 101 Certification
• Clear Communication

Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
• Wellness incentives with mental well-being resources for employees and their dependents, including counseling services, stress management programs, and mindfulness programs.
• Generous paid time off.
• Tuition assistance for undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• For hybrid employees: flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
• For hybrid employees: commuter perks.
• For hybrid employees: free convenient on-site parking.
• For hybrid employees: subsidized on-campus cafes.
• For hybrid employees: on-site activities such as health and wellness events, coffee connects, and disaster preparedness fairs.
• For hybrid employees: fitness and well-being center with in-person and virtual workouts and nutritional counseling.
• For hybrid employees: on-campus shuffleboard and ping pong.

Company

• Health plan providing benefits and wellness services in Alaska, Washington.
• Mountlake Terrace, Washington, USA
• https://www.premera.com/
• Founded in 1933
• 1001-5000 employees

Qualifications

• High school diploma or GED
• Three (3) years of claims, customer service or enrollment work experience, which includes one (1) year of quality audit, quality control, or quality assurance experience
• May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately
• Quality 101 certification
• Three (3) years of claims, customer service or enrollment work experience, which includes one (1) year of quality audit, quality control, or quality assurance experience.

Required skills

• Bilingual English/Spanish, Claims Processing, Enrollment, Quality 101 Certification, Quality Auditing

Preferred skills

• Quality 101 certification

Experience

• 3+ years