Quality Specialist III

About this role

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. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: . The Audit Specialist III provides audit feedback for customer service and claims associates to help meet Company goals. This position will audit and review select processes and procedures such as claims inquiries and enrollment transactions to ensure accuracy and improve performance. Key responsibilities include the development, maintenance and tracking of related audit procedures to meet defined requirements. Incumbents will conduct audits for assigned areas to monitor, document, and trend results. They will also provide suggestions for management on plan improvement and will help provide effective coaching to associates. What you will do: Review and make available a variety of 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, or inquiries for transaction 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 to make recommendations on policy and procedural revisions. Track, monitor, update, respond to, and follow-up with providers, members, associates, technical support staff and team leaders on audit findings, action plans, and information requests to ensure each item on the action plan is completed in a timely and accurate manner and achieving desired results. Provide consistent feedback, question support, and training for associates to help implement changes that will result in efficiencies and reduce errors. Conduct both new hire training and cross training of existing associates as needed to support the business. Develop and maintain desk procedures and workflow for position and audits performed. Complete special projects and perform other duties as assigned. What you will bring: 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 computer in a Windows environment, including Visio, Access and Power point and Internet (DSHS, OIC regulations, HCFA, Public use files, etc.). (Preferred) Project management experience. (Preferred) Experience with MTM, FEP, or in-team auditing techniques. (Preferred) Quality 101 certified. (Preferred) What you will gain: Advanced auditing and quality assurance experience. Stronger data analysis and root cause skills. Experience coaching and training associates. Opportunities to improve policies and workflows. Broader knowledge of healthcare operations and compliance. 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 prim

Skills and categories