Quality Specialist III

Job Summary

As a pivotal player in ensuring compliance and quality excellence, the full-time telecommuting Quality Specialist III will conduct complex audits, provide training on auditing processes, and collaborate with various departments to enhance member satisfaction and operational efficiency.

Key responsibilities

• Lead training sessions for Quality Specialists on audit processes and tools
• Conduct complex audits to verify compliance with BCBSA and FEP standards
• Act as a consultant to resolve high-impact business issues and recommend quality assurance action plans

Required qualifications

• Four years of customer service, claims, or membership and billing experience in a healthcare or insurance environment
• Two years of experience in training or audit functions
• Experience with operational procedures
• Quality certification such as Certified Quality Auditor (CQA) or Quality Improvement Associate (CQIA)
• Bachelor's Degree or four years of related experience