Quality Specialist II

Premera Blue Cross

Mountlake Terrace, WA(remote)

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JOB DETAILS

SALARY

$48,400–$72,600 Per Year

SKILLS

Analysis Skills, Auditing, Blog, Business Processes, Change Management, Claims Processing, Communication Skills, Conflict Resolution, Consulting, Corporate Compliance, Corporate Policies, Corrective Action, Customer Experience, Customer Relations, Customer Support/Service, Data Collection, Environmental Impact, Federal Contracts, Federal Laws and Regulations, Fitness, Health Plan, Healthcare, High School Diploma, Incentive Programs, Maintain Compliance, Material Audit, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Negotiation Skills, Nutrition Therapy, Operations Guidelines, Problem Solving Skills, Procedure Development, Process Improvement, Quality Assurance, Quality Control, Quality Management, Quality Metrics, Quality Monitoring, Staff Motivation, State Laws and Regulations, Team Lead/Manager, Trend Analysis, Tuition Fees, Work From Home, Writing Skills

LOCATION

Mountlake Terrace, WA

POSTED

30+ days ago

**Workforce Classification:** Telecommuter **Join Our Team: Do Meaningful Work and Improve People's Lives** Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we're able to better serve our customers. It's this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. (https://www.premera.com/visitor/careers#awards) Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/ . **_About the role of Quality Specialist II_** As a **_Quality Specialist II_** , you will be responsible for overseeing Premera's compliance with corporate audit programs such as the Blue Cross Blue Shield Association (BCBSA) Member Touchpoint Measures (MTM), 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. You will perform daily examination and verification of Premera transactions, such as claims processing, customer inquiries, group and member enrollment, and electronic data exchange. You will also monitor 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. You will work in conjunction with stakeholders to identify opportunities for quality improvement throughout the company. **This is a virtual/remote position, working from home.** **What you'll 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 workgroups regarding Quality Review and 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. **What you'll bring:** + High School Diploma or GED. **(Required)** + (3) years of claims, customer service, or enrollment work experience, which includes (1) year of quality audit, quality control, or quality assurance experience. **(Required)** + Demonstrated skills in Microsoft Office Suite: Outlook, Access, Word, Excel, and PowerPoint. + A critical thinker with demonstrated natural curiosity to understand how things work and approach problems in a consistent and systematic way. + Demonstrated skills in Microsoft Office Suite: Outlook, Access, Word, Excel, and PowerPoint. + Strong analytical skills - demonstrated ability to collect, assimilate, synthesize data using various data collection techniques and validating accuracy. + Strong problem solving skills - demonstrated ability to solve a variety of complex problems in the absence of technical guidelines or precedents. + Proven ability to use effective negotiation techniques to resolve disputes in a tactful and respectful manner. + Ability to manage change and have a pro-active approach to work. + Strong presentation, written and communication skills and ability to communicate effectively with all levels of management. + Highly adaptable and motivated employee. + Listens carefully to fully understand opposing viewpoints, assuming good intent. **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. + Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. + Employee recognition program to celebrate anniversaries, team accomplishments, and more. For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement. + Commuter perks make your trip to work less impactful on the environment and your wallet. + Free convenient on-site parking. + Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable. + Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. + Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. + Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus. **Equal employment** **opportunity/affirmative** **action:** Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. **Premera is hiring in the following states, with some limitations based on role or city:** Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin _._ The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally target up to and around the midpoint of the range. **National Salary Range:** $48,400.00 - $72,600.00 **National Plus Salary Range:** $55,200.00 - $82,800.00 _*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska_ _._ We're happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We're committed to creating an environment where all employees are celebrated for their unique skills and contributions. At Premera, we make healthcare work better. By focusing on improving our customers' experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services. Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.

About the Company

Premera Blue Cross

INDUSTRY

Other/Not Classified