Quality Specialist III

🔥 21 hours ago

🐻 Alaska, Arizona, +25 more states – Remote

🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $52.4k - $78.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

📋 Description

• Review and make available audit reference materials and data, including case reviews, bulletins, programs, brochures, memos, and spreadsheets • Audit team and individual associates' calls and sample items such as enrollments, claims, and inquiries for compliance, accuracy, completeness, and timeliness • Identify, research, analyze, and record audit findings • Complete trending and root cause analysis to reduce errors and improve behaviors • Review data and recommend policy and procedural revisions • Track, monitor, update, respond to, and follow up on audit findings, action plans, and information requests • Provide feedback, question support, and training for associates • Conduct new-hire training and cross-training as needed • Develop and maintain desk procedures and workflows for the position and audits performed • Complete special projects and other assigned duties

🎯 Requirements

• Two (2) 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 curriculum development and design (Preferred) • Experience with Premera's technical platforms (Preferred) • Experience with Premera's operational procedures (Preferred) • Experience with call monitoring software (Preferred) • Skills operating a computer in a Windows environment, including Visio, Access, PowerPoint, Internet, DSHS, OIC regulations, HCFA, and public use files (Preferred) • Project management experience (Preferred) • Experience with MTM, FEP, or in-team auditing techniques (Preferred) • Quality 101 certified (Preferred) • Ability to keyboard and communicate clearly and understandably in person and over the telephone • Ability to perform essential physical requirements with or without accommodation

🏖️ Benefits

• Medical, vision, and dental coverage with low employee premiums • Voluntary benefit offerings, including pet insurance • Life and disability insurance • Retirement programs, including a 401K employer match and pension plan vested after 3 years of service • Wellness incentives, including counseling services, stress management programs, and mindfulness programs • Generous paid time off • Tuition assistance for undergraduate and graduate degrees • Employee recognition program • Commuter perks • Free convenient on-site parking • Subsidized on-campus cafes • On-site health and wellness activities • Fitness and well-being center with in-person and virtual workouts and nutritional counseling