Quality Specialist II

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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.

• 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.

• 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…