Quality Specialist III

About the role

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.

Responsibilities

• 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.

Requirements

• 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

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.

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.
• For our hybrid employees, 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.
• 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.

Pay

National Salary Range: $52,400.00 - $78,600.00. National Plus Salary Range: $59,800.00 - $89,700.00 (used in higher cost of labor markets including Western Washington and Alaska).