Enrollment Quality Assurance Specialist

Premera Blue Cross; Maine; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health coverage

Pension plan

Tuition assistance

On-site parking

Fitness center

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform complex enrollment, eligibility, billing changes, and reconciliation while delivering exceptional customer service to members and agents. The role uses multiple systems and requires collaboration with cross-functional teams.

The position supports 7:00 AM to 5:00 PM PT coverage with one late shift per week, and may require additional coverage. Strong audits and regulatory understanding are essential to success.

Qualifications

• Two years of accounting/finance/bookkeeping or enrollment processing experience.
• Health or insurance industry experience.
• Expertise in complex enrollment, eligibility, billing, and reconciliation processes.
• Experience conducting audits and improving quality and efficiency.
• Increased knowledge of healthcare regulations and administrative guidelines.
• Collaboration experience with customers, partners, and cross-functional teams.

Responsibilities

• Provides technical support to assigned teams/partners by researching and troubleshooting issues related to processing, system, and software applications.
• Represents department on cross-functional teams and meets with external customers as required.
• Regularly reviews procedures and training material to outline and implement improvements for increased efficiency.
• Update eligibility, enrollment and/or billing of accounts.
• Educate agents and members on general membership and billing processes and administrative rules; may include Web portal usage and contract or regulation interpretation.

Skills

Enrollment processing

Auditing

Customer service

Healthcare regulations

Education

High School diploma or GED

Two years accounting/finance or enrollment processing

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform complex enrollment, eligibility, billing changes, and reconciliation while delivering exceptional customer service to members and agents. The role uses multiple systems and requires collaboration with cross-functional teams.

The position supports 7:00 AM to 5:00 PM PT coverage with one late shift per week, and may require additional coverage. Strong audits and regulatory understanding are essential to success.