Quality Specialist III

Workforce Classification:

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.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.premera.com/.

Are you passionate about driving quality and making a meaningful difference in the lives of members? As a Quality Specialist III, you will play a pivotal role in ensuring every member experience meets the highest standards of excellence. Your expertise will directly impact member satisfaction and trust by safeguarding compliance, supporting audit processes, and fostering a culture of continuous improvement—helping us deliver care and service our members can rely on, every step of the way.

The Quality Specialist III is responsible for conducting and overseeing Premera’s compliance with corporate audit programs such as the Blue Cross Blue Shield Association (BCBSA) Local Operations Scorecard (LOS) and Licensee Desk Level Audit (LDLA), the Federal Employee Program (FEP) audit and tier  II support to customer service representatives and QA teams, both offshore and onshore, along with ensuring compliance with state and federal laws, contracts and the achievement of corporate objectives. The Quality Specialist III has the ability to audit a wide variety of audits and is considered a technical expert. In addition to conducting complex audits, the Quality Specialist III is also responsible for hands-on training to assist auditors on auditing techniques and practices. The Quality Specialist III ensures the Quality Review & Reporting (QRR) team has the necessary tools, processes, procedures and training needed to support the end-to-end audit process. They evaluate business needs, legal/compliance documents and lead calibration meetings. They will also guide/recommend training on new or modified auditing methods or systems, analyze system and process enhancement requests, evaluate quality and compliance within the department, and recommend appropriate employee development and training opportunities. The Quality Specialist III acts in a consulting capacity with other departments to identify opportunities for improvement throughout the company and assist in the coordination of project based as well as external customer audits.

What you will do:

• Lead and organize training for all Quality Specialists on audit processes, procedures, and tools.
• Conduct complex audits and verifying quality standards for selected inquiries and make decisions whether discrepant information meets BCBSA and FEP audit requirements, state, and federal mandates.
• Provide second-level support on escalated issues and audit findings.
• Collaborate with team members, OCLD, and management to identify training gaps and business needs and implement actions while partnering to address these issues.
• Review, evaluate, and provide feedback on trainees’ audits and learning processes.
• Act as a consultant with external departments to help resolve high-impact business issues by recommending action plans related to quality assurance.
• Assist the Data Reporting Analyst in collecting data and providing analyses for various issues across the d