Enrollment Oversight & Quality Specialist

About the Role

Join Premera Blue Cross and contribute to transforming healthcare by ensuring the accuracy and compliance of enrollment processes. As an Enrollment Oversight & Quality Specialist, you will play a crucial role in managing complex enrollment cases, collaborating with partners, and enhancing quality assurance to boost customer satisfaction. This position demands exceptional problem-solving abilities, customer service excellence, and compliance awareness in a dynamic setting.

Key Responsibilities

• Analyze and apply plan provisions and regulatory standards to individual and group enrollment situations ensuring adherence to federal and state laws.
• Provide advanced technical assistance related to processing systems and software for assigned teams and strategic partners.
• Investigate complex eligibility issues and determine appropriate resolutions, escalating concerns when necessary.
• Conduct regular performance audits to verify accuracy, compliance, and timely completion of transactions, suggesting and implementing process enhancements.
• Represent the department in cross-functional meetings and external customer engagements as needed.
• Review and update procedures and training materials in partnership with quality coaching and training teams to maximize efficiency.
• Offer backup support across enrollment and billing operations during peak times and participate in special projects.
• Monitor audit outcomes, coordinate corrective actions with partners, and ensure timely resolution of audit-related tasks.
• Handle complex enrollment transactions such as plan changes, dependent additions, transfers, and billing updates with accuracy.
• Communicate with members and agents to clarify enrollment matters and provide guidance on administrative and regulatory protocols, including composing written correspondence.
• Maintain or exceed established departmental productivity and quality standards.
• Educate agents and members on membership processes, billing, use of web portals, and interpretation of contracts or regulations.

Qualifications

• High school diploma or GED is mandatory.
• At least two years of experience in accounting, finance, bookkeeping, or enrollment processing.
• Associate degree in accounting preferred.
• Prior customer service experience is required.
• Background in health or insurance industry is advantageous.

Skills and Expertise Development

• Acquire in-depth knowledge of regulatory and compliance standards related to enrollment.
• Enhance technical troubleshooting and systems problem-solving skills.
• Develop audit execution and process improvement capabilities.
• Strengthen communication and customer service aptitude.
• Gain experience in cross-team collaboration and instructional support.

Physical and Work Environment

• This largely sedentary role occasionally requires exerting up to 10 pounds of force.
• Must be able to operate a keyboard efficiently and communicate clearly both in person and via telephone.

Compensation and Benefits

• Competitive salary ranging approximately from $41,500 to $62,300 annually with higher ranges in select markets.
• Comprehensive medical, dental, and vision insurance with low premiums.
• Voluntary benefits including pet insurance.
• Life and disability coverage.
• Retirement plans with 401(k) match and a vested pension after three years.
• Wellness programs covering mental health resources and stress management.
• Tuition assistance for eligible continuing education.
• Generous paid vacation time.
• Employee recognition initiatives.
• Commuter benefits, on-site parking and meal subsidies.
• Access to fitness and well-being facilities including virtual options.

Diversity and Inclusion

Premera is an equal opportunity employer committed to diversity and inclusion across race, gender, age, disability, and other protected characteristics. Accommodations for applicants are available upon request.

Geographic Opportunities

Openings exist across numerous states including Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, and Wisconsin.