Improve customers' lives by making healthcare work better.
Quality Specialist III
Location
Alaska + 26 moreAll locations: Alaska | Arizona | California | Colorado | Florida | Idaho | Iowa | Kansas | Kentucky | Maine | Montana | Nevada | New Hampshire | New Mexico | North Carolina | Oklahoma | Oregon | Michigan | Minnesota | Missouri | South Carolina | South Dakota | Tennessee | Texas | Utah | Washington | Wisconsin
Posted
6 days ago
Salary
$52.4K - $78.6K / year
Seniority
Senior
Job Description
Quality Specialist III
Premera Blue Cross
• Lead and organize training for all Quality Specialists on audit processes, procedures, and tools. • Conduct complex audits and verifying quality standards for selected inquiries and make decisions whether discrepant information meets BCBSA and FEP audit requirements, state, and federal mandates. • Provide second-level support on escalated issues and audit findings. • Collaborate with team members, OCLD, and management to identify training gaps and business needs and implement actions while partnering to address these issues. • Review, evaluate, and provide feedback on trainees’ audits and learning processes. • Act as a consultant with external departments to help resolve high-impact business issues by recommending action plans related to quality assurance. • Assist the Data Reporting Analyst in collecting data and providing analyses for various issues across the department and other functional areas. • Foster a training and auditing culture that values diversity of thought, leveraging team member strengths to achieve team goals. • Assist with external audits and lead special projects. • Perform other duties as assigned.
Job Requirements
- Four (4) years of customer service, claims or membership and billing experience in a call center, healthcare, or insurance environment (Required).
- Two (2) years of experience in training or audit functions (Required).
- Experience with operational procedures (Required).
- Completion of internal or external courses dealing with facilitation skills, conflict management, dealing with difficult people, etc.
- Quality certification such as Certified Quality Auditor (CQA), Quality Improvement Associate (CQIA), Quality Process Analyst Certification (CQPA).
- Bachelor’s Degree or four years related experience.
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 a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
- Generous paid time off to reenergize.
- Tuition assistance for both undergraduate and graduate degrees.
- Employee recognition program to celebrate anniversaries, team accomplishments, and more.
- Commuter perks make your trip to work less impactful on the environment and your wallet.
- Free convenient on-site parking.
- Subsidized on-campus cafes.
Related Guides
Related Job Pages
More Quality Specialist Jobs
Quality Specialist
NexRep, LLCNexRep delivers world-class customer service and sales solutions with a network of highly skilled home-based agents.
• Analyze calls, emails, social media posts, and/or SMS contacts of NexRep’s independent contractors • Identify trends and work with certification and operations teams • Monitor agents in real time or after the fact • Review contacts for customer satisfaction • Provide recommendations for client’s quality scorecard • Participate in calibration sessions with NexRep's client • Provide feedback to NexRep certification and operations team • Review customer satisfaction data to identify trends • Facilitate town hall sessions for independent contractors
Healthcare Quality Management Specialist
Medical Review Institute of America, LLCQuality, Innovation, and Experience: Setting Us Apart
• partner with key members of leadership for the design and implementation of Quality Management procedures • ongoing improvement efforts, and other team projects with the aim of achieving organizational, accreditation, and regulatory requirements • Review and analyze current processes related to the application and implementation of policies, procedures, and practices • provide leadership with recommendations for updates to comply with the current regulatory and accreditation requirements • Identify gaps in efficient process workflow and suggests steps for quality process improvement • Measure process performance using valid and accurate methods; analyze trends, variation, and process stability to determine if defined performance metrics are met and identify areas of risk • lead and support structured quality improvement initiatives (e.g. DMAIC or equivalent) • Manage and lead Quality Improvement Projects (QIPs) • Manage and ensure execution of CAPAs, including documented root cause analysis, defined success metrics, implementation tracking, and post-implementation validation demonstrating sustained improvement in coordination with the Clinical Quality, Compliance, and Operations leaders • Serve as liaison between clients and MRIoA’s quality management department as needed • Assist leadership in establishing and reporting quality metrics
• Facilitates routine evaluations to assess the extent to which individuals with intellectual developmental disabilities (IDD) are receiving customized support and services • Performs scheduled reviews to assess effectiveness of IDD service providers • Assists management in identifying areas for improvement in service delivery • Analyzes data related to program outcomes and client satisfaction
Automotive Quality Check Specialist
Sonic AutomotiveDelivering an experience for our guests and our teammates that fulfills dreams, enriches lives and delivers happiness
• Cosmetic inspections, quality assurance, photograph vehicles and ensure vehicles’ readiness for sale • Work in a high volume, team-based environment • Operate vehicles accurately and safely throughout the lot • Assist in the valet process as needed




