Enrollment Oversight & Quality Specialist

Premera; Washington; Hybrid; USD 42,000 - 71,000; Full time

Job summary

Premera is hiring an Enrollment Oversight and Quality Specialist to perform moderate to complex enrollment, eligibility, billing changes and reconciliation, with strong customer service and clear communication with members, agents, and internal teams.

You will review plan provisions, apply federal and state guidelines, conduct audits, and support improvement of enrollment and billing processes while meeting quality standards in a fast-paced health‑care environment.

Qualifications

• High School diploma or GED required.
• Minimum of two (2) years of accounting/finance/budgeting or enrollment processing experience.
• Associate’s degree in accounting preferred.
• Previous customer service experience preferred.
• Health or insurance industry experience preferred.

Responsibilities

• Review plan provisions and apply rules for Individual or Group enrollment scenarios with applicable federal/state guidelines.
• Provide technical support to teams by researching and troubleshooting issues related to processing, systems, and software applications.
• Act as a resource for customers by researching complex system issues affecting eligibility and determining appropriate actions.
• Conduct performance audits to ensure transaction accuracy and timeliness; identify and implement process improvements.
• Educate agents and members on membership and billing processes and administrative rules; may include Web portal usage.

Skills

Customer service

Research

Troubleshooting

Communication

Attention to detail

Education

High School diploma or GED

Associate’s degree in accounting

Tools

Enrollment processing systems

Billing systems

Job description

Workforce Classification: Telecommuter Join Our Team: 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. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/. The Enrollment Oversight and Quality Specialist will perform moderate to complex enrollment, eligibility, billing changes and reconciliation, and account research using a variety of methods, systems and platforms. This role is expected to have exceptional customer service skills and interact with internal and external customers in a timely and professional manner via phone, email or written correspondence within established department turnaround times. Must be able to thoroughly explain administrative and regulatory guidelines, their impact and offer alternatives to our members/agents. This position will provide support and coordination to assist in the management and improvement of assigned audit processes. This role will include the development, maintenance and tracking of related audits, procedures, and efficiency work in team and as it relates to our strategic implementation partners. Candidates must be available to support business operations during the department's 7:00 AM to 5:00 PM PT coverage window. This role also requires participation in a late-shift rotation, typically one day per week, with occasional additional coverage based on business needs. Late-shift hours are 8:30 AM to 5:0PM PT.

What you will do:

• Responsible for reviewing plan provisions and applying specific rules inherent to Individual or Group enrollment scenarios. Apply contractual, state and federal guidelines as appropriate, ensuring work follows federal and state regulations.
• Provides technical support to assigned teams/strategic implementation partners by researching and/or troubleshooting issues related to processing, system, and software applications.
• Serves as a resource for customers by researching complex systems issues impacting member eligibility and determining appropriate course of action. Escalate issues or concerns to ensure desired results.
• Conduct performance audits to ensure transaction compliance, accuracy and timeliness. Identifies, recommends and implements process improvements.
• Represents department on cross‑functional teams and meets with external customers as required.
• Regularly reviews procedures and training material for in‑team and strategic implementation partner training, through partnership with the training and quality coaching teams, to outline and implement improvements for increased efficiency.
• Provide back‑up and peak‑load assistance across Enrollment & Billing as needed; complete special projects and perform other duties as assigned.
• Tracks, monitors, updates, and follows‑up with strategic implementation partner on audit findings, action plans, and information requests to ensure each item on the action plan is completed in a timely and accurate manner.
• Process plan changes, dependent add‑ons, direct transfers, transfer accumulators and more challenging types of enrollments. Update eligibility, enrollment and/or billing of accounts.
• Contact customers or Producer agents for enrollment clarification and/or to provide administrative/regulatory guidelines. This may include creating written correspondence regarding complex billing and enrollment issues.
• Must meet or exceed department production and quality standards and remain current on company/departmental policies and procedures.
• Educate agents and members on general membership and billing processes and administrative rules; may include Web portal usage and contract or regulation interpretation.
• Perform other duties as assigned.

What you will bring:

• High School diploma or GED. (Required)
• Minimum of two (2) years of accounting/finance/bookkeeping experience or two (2) years enrollment processing experience. (Required)
• Associate’s degree in accounting. (Preferred)
• Previous customer service experience. (Preferred)
• Health or insurance industry experience. (Preferred)

What you will gain:

• Expertise in complex enrollment, eligibility, billing, and reconciliation processes
• Experience conducting audits and improving quality and efficiency
• Stronger research, troubleshooting, and problem‑solving skills
• Increased knowledge of healthcare regulations and administrative guidelines
• Collaboration experience with customers, partners, and cross‑functional teams

Physical Requirements:

• 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 use a keyboard and to communicate clearly and understandably in person and over the telephone.

Premera total rewards

• 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, believe it or not, 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.

Equal employment opportunity/affirmative action

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 [e-mail] or via phone at 425‑918‑4785.

Premera is hiring in the following states, with some limitations based on role or city: 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, Wisconsin.

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 Salary Range: $41,500.00 - $62,300.00 National Plus Salary Range: $47,400.00 - $71,100.00 *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.

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services. Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.