Enrollment & Quality Assurance Specialist

Premera Blue Cross; Town of King (WI); On-site; USD 50,000 - 75,000; Full time

Benefits offered by this job

Medical, vision, dental coverage

401(k) employer match

Pension plan after 3 years

Tuition assistance

On-site parking

Hybrid on-campus model

Well-being center and fitness programs

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform enrollment, eligibility, billing changes, and reconciliation across multiple systems. The role emphasizes exceptional customer service, clear communication with members and agents, and timely handling of inquiries.

The position supports operations during 7:00 AM–5:00 PM PT with a late-shift rotation once weekly, and may require additional coverage.

Qualifications

• High School diploma or GED; 2 years accounting/finance or enrollment processing experience preferred.
• Experience conducting audits and improving quality and efficiency.
• Knowledge of healthcare regulations and administrative guidelines.
• Collaboration with customers, partners, and cross-functional teams.

Responsibilities

• Provide technical support to assigned teams and partners by researching and troubleshooting issues related to processing, systems, and software applications.
• Research complex systems issues impacting member eligibility and determine appropriate action; conduct performance audits for compliance and timeliness; identify and implement process improvements.
• Represent department on cross-functional teams and meet with external customers as required.
• Review procedures and training materials to improve efficiency in-team and with strategic implementation partners.
• Complete special projects and perform other duties as assigned.
• Track and follow up with strategic partners on audit findings and action plans to ensure timely closure.
• Update eligibility, enrollment, and billing information.
• Contact customers or Producer agents for enrollment clarification and to explain guidelines; draft correspondence for complex billing/enrollment issues.
• Meet or exceed department production and quality standards and stay current on policies.
• Educate agents and members on general membership and billing processes and regulatory interpretations.

Skills

Customer service

Analytical thinking

Research skills

Communication skills

Time management

Education

High School diploma or GED

Tools

Enrollment platforms

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform enrollment, eligibility, billing changes, and reconciliation across multiple systems. The role emphasizes exceptional customer service, clear communication with members and agents, and timely handling of inquiries.

The position supports operations during 7:00 AM–5:00 PM PT with a late-shift rotation once weekly, and may require additional coverage.