Quality Specialist III

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:  https://healthsource.premera.com/.

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 primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone.
 

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 [email protected] 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:

$52,400.00 - $78,600.00

National Plus Salary Range:

$59,800.00 - $89,700.00

*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.