Enrollment Quality & Compliance Specialist

Premera Blue Cross; Clayton (NC); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

401K employer match

Tuition assistance

Generous paid time off

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform moderate to complex enrollment, eligibility, billing changes and reconciliation. You will support audit processes, maintain procedures, and provide timely customer service via phone, email, or written correspondence.

The role requires advising on regulatory guidelines, training materials, and collaboration with internal and external partners to improve efficiency.

Qualifications

• 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)

Responsibilities

• Review plan provisions and apply rules for Enrollment scenarios while following state/federal regulations.
• Provide technical support to teams/partners by researching issues related to processing and software applications.
• Assist customers by researching eligibility issues and determining appropriate actions; escalate when needed.
• Conduct performance audits to ensure compliance, accuracy, and timeliness; identify process improvements.
• Collaborate with cross-functional teams and external customers as required.
• Educate agents and members on enrollment and billing processes and regulations.

Skills

Enrollment processing

Customer service

Accounting/finance

Education

High School diploma

Associate degree in accounting

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform moderate to complex enrollment, eligibility, billing changes and reconciliation. You will support audit processes, maintain procedures, and provide timely customer service via phone, email, or written correspondence.

The role requires advising on regulatory guidelines, training materials, and collaboration with internal and external partners to improve efficiency.