Enrollment Quality & Audit Specialist

Premera Blue Cross; Lake Michigan Beach (MI); Hybrid; USD 52,000 - 64,000; Full time

Benefits offered by this job

Medical, vision, dental coverage

401K with employer match

Pension plan after 3 years

Tuition assistance for undergrad and 


Hybrid on-site model

Free on-site parking

Well-being center on-site

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes, reconciliation, and audits. You will interact with members, agents, and partners via phone, email, or written correspondence, explaining regulatory guidelines and offering alternatives.

The role requires supporting operations within a 7:00 AM–5:00 PM PT window, plus late-shift rotations.

Qualifications

• High school diploma or GED required.
• Two years accounting/finance/bookkeeping experience or two years enrollment processing experience.
• Health or insurance industry experience preferred.
• Expertise in complex enrollment, eligibility, billing, and reconciliation processes.
• Experience conducting audits and improving quality and efficiency.
• Knowledge of healthcare regulations and administrative guidelines.
• Collaborate with customers, partners, and cross-functional teams.

Responsibilities

• Provide technical support to teams and implementation 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.
• Represent the department on cross-functional teams and meet with external customers as required.
• Review procedures and training materials to improve efficiency with training and QA teams.
• Complete special projects and assist with audits, action plans, and data requests.
• Update eligibility, enrollment and billing records as needed.
• Educate agents and members on membership and billing processes and regulatory rules.

Skills

Customer service

Enrollment processing

Audits

Regulatory knowledge

Collaboration

Education

High school diploma or GED

Tools

CRM systems

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes, reconciliation, and audits. You will interact with members, agents, and partners via phone, email, or written correspondence, explaining regulatory guidelines and offering alternatives.

The role requires supporting operations within a 7:00 AM–5:00 PM PT window, plus late-shift rotations.