Provider Customer Service Quality Specialist II

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.

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/.

If you’re passionate about accuracy, continuous improvement, and making a measurable impact on how work gets done, this is your opportunity to step into the Provider Quality Specialist II role and influence quality outcomes across the organization. In this role, you won’t just review work—you’ll help shape standards, elevate performance, and partner with teams to drive meaningful improvements that support our business goals.

As a Quality Specialist II, you’ll build on your experience by applying critical thinking, audit expertise, and collaboration skills to strengthen processes, identify trends, and support both onshore and offshore teams. This is an ideal next step for someone who enjoys coaching, problem‑solving, and being a trusted quality resource while continuing to grow professionally within our organization.

The Quality Specialist II is responsible for overseeing Premera's compliance with corporate audit programs such as the Blue Cross Blue Shield Association (BCBSA) Member Touchpoint Measures (MTM) and Licensee Desk Level Audit (LDLA), the Federal Employee Program (FEP) audit and tier I support within customer service offshore and onshore teams, along with ensuring compliance with state and federal laws, contracts and the achievement of corporate objectives. The Quality Specialist II performs daily examination and verification of Premera transactions, such as claims processing, customer inquiries, group, member enrollment, electronic data exchange and daily examination and enrollment and electronic data exchange transactions. The Quality Specialist II monitors 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. The Quality Specialist II will work in conjunction with stakeholders to identify opportunities for quality improvement throughout the company.

What you will do:

• 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 & 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.
• Other duties as assigned.

What you will bring:

• High school diploma or GED (Required).
• Three (3) years of claims, customer service or enrollment work experience, which includes one (1) year of quality audit, quality control, or quality assurance experience (Required).
• Experience in operating comp