Quality Specialist Ii Jobs

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.

Forbes ranked Premera among America’s 2023 Best Midsize Employers because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

As a Quality Specialist II, you will be responsible for overseeing Premera's compliance with corporate audit programs such as the Blue Cross Blue Shield Association (BCBSA) Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and the Federal Employee Program (FEP) audit, along with ensuring compliance with state and federal laws, contracts, and the achievement of corporate objectives. You will perform daily examination and verification of Premera transactions, such as claims processing, customer inquiries, group and member enrollment, and electronic data exchange. You will also monitor all quality standards for selected claims, inquiries, enrollments, and/or electronic transactions for accuracy, completeness, and timeliness to judge the degree of adherence to the criteria set forth by the BCBSA, FEP, and corporate policy requirements. You will work in conjunction with stakeholders to identify opportunities for quality improvement throughout the company.

This is a virtual/remote position, working from home.

What you’ll do:

• 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.
• Help individuals and the team become stronger by actively participating, leading, and facilitating team meetings and workgroups regarding Quality Review and Reporting initiatives and incentives.
• Assist in consulting with external departments to help resolve high impact key business issues surrounding quality assurance.
• Resolve conflict directly and respectfully, engaging in challenging and important conversations to resolve audit findings.
• Conduct audits in a professional, ethical, and objective manner using and interpreting applicable standards/requirements.
• Identify trends and the root cause of errors and recommend improved procedures/guidelines to Operations proactively.
• Understand quality principles as they relate to business processes and explain the importance of aligning the audit function to the organization.
• Effectively plan, develop, and communicate an audit within a defined scope, including resource scheduling. Conduct necessary meetings in performance of the audit.

What you’ll bring:

• Demonstrated skills in Microsoft Office Suite: Outlook, Access, Word, Excel, and PowerPoint.
• Bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately preferred.
• Quality 101 certification preferred.
• (3) years of claims, customer service, or enrollment work experience, which includes (1) year of quality audit, quality control, or quality assurance experience. (Required)
• High School Diploma or GED. (Required)

What We Offer

• Tuition assistance for undergraduate and graduate degrees
• Retirement programs (401K employer match and pension plan)
• Life and disability insurance
• Generous Paid Time Off to reenergize
• Medical, vision and dental coverage
• Free parking
• Wellness incentives, onsite services, a discount program and more

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

National Salary Range:

$44,900.00 - $67,300.00

National Plus Salary Range:

$50,700.00 - $76,100.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.