Quality Specialist

• 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 department and other functional areas.
• Foster a training and auditing culture that values diversity of thought, leveraging team member strengths to achieve team goals.
• Assist with external audits and lead special projects.
• Perform other duties as assigned.

Quality Specialist III ensuring compliance and conducting complex audits at Premera.

Quality Specialist III

Quality Specialist III role at Premera focusing on compliance, quality assurance, and auditing within healthcare services.

• Analyze calls, emails, social media posts, and/or SMS contacts of NexRep’s independent contractors
• Identify trends and work with certification and operations teams
• Monitor agents in real time or after the fact
• Review contacts for customer satisfaction
• Provide recommendations for client’s quality scorecard
• Participate in calibration sessions with NexRep's client
• Provide feedback to NexRep certification and operations team
• Review customer satisfaction data to identify trends
• Facilitate town hall sessions for independent contractors

Quality Specialist at NexRep analyzing and ensuring client standards

Quality Specialist at NexRep responsible for analyzing calls and ensuring compliance with client standards. Working collaboratively with operations and certification teams to provide feedback and improvement.

Quality Specialist jobs in Maine

See all jobs on JobTailor

Quality Specialist III

Quality Specialist