Premera Blue Cross logo
Premera Blue Cross

Improve customers' lives by making healthcare work better.

Quality Specialist III

Quality SpecialistGeneralFull TimeRemoteSeniorTeam 1,001-5,000Since 1945H1B SponsorCompany SiteLinkedIn

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

Bachelor Degree4 yrs expEnglish

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.

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