Quality Specialist III (Healthcare Quality Assurance)

Location: Telecommuter; hiring is limited to listed U.S. states, including Washington and Alaska

Salary: $52,400–$78,600 national range; $59,800–$89,700 national plus range for higher-cost labor markets

Company

hirify.global is a healthcare organization focused on improving healthcare services and customer outcomes.

What you will do

• Review audit reference materials, case reviews, policies, procedures, bulletins, and operational data.
• Audit calls, enrollments, claims, and inquiries for compliance, accuracy, completeness, and timeliness.
• Research, analyze, document, and trend audit findings, including root cause analysis.
• Track action plans and follow up with providers, members, associates, technical support staff, and team leaders.
• Provide feedback, question support, onboarding training, and cross-training to associates.
• Develop desk procedures, audit workflows, and recommendations for policy and process improvements.

Requirements

• At least two years of customer service, claims, membership, or billing experience in a call center, healthcare, or insurance environment.
• At least two years of experience in training or audit functions.
• Ability to operate a computer in a Windows environment.
• Primarily sedentary work requiring keyboard use and clear communication by telephone and in person.

Nice to have

• Curriculum development and design experience.
• Experience with Premera technical platforms and operational procedures.
• Call monitoring software experience.
• Experience with Visio, Access, PowerPoint, Internet resources, project management, MTM, FEP, or in-team auditing techniques.
• Quality 101 certification.

Culture & Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Life and disability insurance, a 401(k) employer match, and a pension plan vested after three years.
• Wellness resources, counseling, stress management, and mindfulness programs.
• Paid time off, tuition assistance, and employee recognition programs.
• Additional on-campus resources and commuter benefits are available for hybrid employees.