Quality Specialist III

🔥 17 minutes 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

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

⚕️ 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

• 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.

🎯 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.