Job Description

Responsible for leading the development and implementation of innovative quality assurance solutions that improve operational efficiency, automate manual processes, and enhance audit and quality outcomes. Leading the development and implementation of data-driven, automated, and AI-enabled solutions that improve quality outcomes, operational efficiency, and audit effectiveness. Partners with Quality Assurance, Operations, and Technology teams to transform quality processes, reduce administrative burden, and create scalable solutions that support continuous improvement across the organization.

We are looking for a Specialist with:

Experience: 3 years’ relevant experience

Education: Bachelor’s Degree in Business, Healthcare, or related field; or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

What a day may look like:

• Partner with compliance and operational leaders to identify risks, strengthen controls, and improve oversight processes through data-driven insights. Partner with Quality Assurance leadership and operational teams to assess existing workflows, identify inefficiencies, reduce risk, and improve overall effectiveness.
• Lead initiatives that optimize quality assurance processes, operational procedures, and service delivery models through data-driven analysis and continuous improvement methodologies.
• Utilize root cause analysis, performance assessments, and operational diagnostics to identify improvement opportunities and drive sustainable solutions.
• Measure and monitor the effectiveness of process improvements, ensuring desired outcomes are achieved and business objectives are met.
• Develop and maintain process documentation, workflow maps, business requirements, and implementation plans that support operational consistency and quality performance.
• Lead the design, testing, implementation, and ongoing enhancement of automation, artificial intelligence, and technology-enabled solutions that improve quality monitoring, auditing, reporting, and workflow efficiency.
• Find opportunities to reduce manual effort and increase scalability through automation tools, advanced analytics, system integrations, and AI-driven capabilities.
• Serve as a subject matter expert on reporting technologies, automation platforms, AI solutions, and emerging tools that support quality assurance and operational excellence.
• Research industry trends and innovative technologies, recommending modern solutions that strengthen operational performance and organizational effectiveness.
• Collaborate with Quality Assurance leadership, operational teams, business stakeholders, data teams, and technology partners to define requirements, prioritize initiatives, and implement business solutions.
• Lead cross-functional projects from concept through implementation, including business case development, stakeholder alignment, testing, training, communication, change management, and adoption planning.
• Support audit readiness, compliance monitoring, and quality assurance programs through robust analytics, reporting, and monitoring capabilities.
• Partner with compliance and operational leaders to identify risks, strengthen controls, and improve oversight processes through data-driven insights.

As of the date of this posting, a good faith estimate of the current pay range is $73,321 - $102,650. The position is eligible for an annual incentive bonus (variable depending on company and employee performance).

The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Applicants must be legally authorized to work in the United States at the time of application and throughout employment. The company does not provide employment-based visa sponsorship for this position now or in the future.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.