Quality Specialist II

Workforce Classification:

Telecommuter

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Join the Provider Contact Center Quality Program as a Quality Specialist II and help shape quality across our offshore operations. You’ll partner with teams to identify opportunities, strengthen quality practices, and drive improvements that make a measurable difference. The Quality Specialist II is responsible for overseeing Premera's compliance with corporate audit programs such as the Blue Cross Blue Shield Association (BCBSA) Member Touchpoint Measures (MTM) and 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. The Quality Specialist II performs daily examination and verification of Premera transactions, such as claims processing, customer inquiries, group and member enrollment and electronic data exchange. The Quality Specialist II monitors 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. The Quality Specialist II will work in conjunction with stakeholders to identify opportunities for quality improvement throughout the company.

What you will do:

· 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.

What you will bring:

· High school diploma or GED. (Required)

· 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)

· May require bilingual proficiency in a particular language (English/Spanish) with the ability to articulate messages and information clearly and accurately. (Preferred)

· Quality 101 certification.*** (Preferred)What you will gain:*

· Build expertise in quality auditing and compliance standards.

· Strengthen data analysis and root-cause problem-solving skills.

· Partner across teams to drive quality improvements.

· Gain experience communicating audit findings and recommendations.

Physical Requirements:The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: This is primarily a sedentary role, which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

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, believe it or not, 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, just to name a few.

Generous paid time off to reenergize.