Quality Standards Analyst

Quality Standards Analyst

Join our team and 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.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America's Best Midsize Employers for the fourth time.

The Quality Standards Analyst acts as an internal consultant for compliance and regulatory issues for health plan quality accreditation and governmental program quality compliance. In this highly visible role, this Analyst is working across Premera and is responsible for facilitating the development, planning and implementation of policies, procedures and systems necessary to meet accreditation, health plan function delegation, and other regulatory requirements. The Quality Standards Analyst performs audit and reporting to ensure policies, procedures and systems are sufficient, and can adapt to changing requirements.

What you'll do:

• Provides expert accreditation and regulatory compliance interpretation to Quality Program leadership, and across Premera to ensure optimal accreditation standards and regulatory compliance is maintained.
• Facilitates the interpretation and integration of accreditation and regulatory requirements into the standards workflows of the organization through development and execution of cross-functional projects.
• Responds to audits and other inquiries from private and public regulators. Assists Level II Analysts with contacting regulatory agencies.
• Develop audit and survey educational tools and materials for managers and associates.
• Develops tools for collecting, analyzing and synthesizing data applicable to accreditation and compliance policies, procedures and systems.
• Provides oversight of policies, procedures and systems to ensure that Premera is meeting compliance and regulatory requirements through completion of regularly scheduled audits (e.g. appeal audits, denial audits).
• Identifies trends and patterns that may be targeted opportunities for improvement.
• Maintains organized and effective documentation of all program activities.
• Presents findings and recommendations of accreditation and compliance efforts to appropriate management within Premera.
• Identifies and reports delegation compliance status and risks to Level II Analysts on Business Associates (i.e. Vendors) delegated programs, (including but not limited to) Utilization Management, Case Management or Disease Management through methods such as pre-delegation assessment, annual review, and corrective action oversight.
• Educate and raise the awareness of associates regarding the significance of regulations, to enhance ongoing understanding of and compliance with regulatory requirements.
• Performs other duties as assigned.

What you'll bring:

• Bachelor's degree in health care administration or four (4) years of relevant work experience. (Required)
• Two (2) years of work experience interpreting health plan accreditation (or other relevant compliance such as airline FAA reg; other highly regulated industries) requirements. (Required)
• Six (6) years of work experience interpreting health plan accreditation requirements. (Preferred)
• Four (4) years of work experience with health plan function delegation requirements. (Preferred)
• Four (4) years of work experience with quality compliance for government programs (e.g. CMS). (Preferred)
• Understanding of health plan administration and operations and external health care delivery systems.
• Demonstrated Knowledge of NCQA Accreditation Standards.
• Demonstrated Knowledge of Accreditation Scoring (Standards, HEDIS, & CAHPS).
• Demonstrated Knowledge of health plan function delegation oversight.
• Demonstrated Knowledge of Regulatory Requirements (CMS, OIC, ERISA, HIPAA, & PBR).
• Strong verbal and written communication and presentation skills.
• Demonstrated Competency in Microsoft Office (Word, PowerPoint, Excel, & Outlook).
• Demonstrated Competency in translating Accreditation & Regulatory Requirements into Policies & Deliverables.
• Demonstrated Competency in analyzing and evaluating compliance of Processes, Policies, Reports, and Outcomes.
• Demonstrated Competency in Creating and Monitoring Work Plans to meet requirements.
• Strong analytical and critical thinking skills as well as well-developed consulting skills.
• Ability to manage multiple priorities concurrently.
• Ability to facilitate cross-functional teams to deliver solutions.
• Ability to educate stakeholders in the importance and relevance of regulatory requirements.

Work is performed within a normal office environment with ambient temperatures.

This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone.

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at View email address on click.appcast.io or via phone at View phone number on click.appcast.io.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Plus Salary Range: $78,000.00 - $115,100.00. National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We're happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We're committed to creating an environment where all employees are celebrated for their unique skills and contributions.