Enrollment Quality & Compliance Specialist

Premera Blue Cross; Crystal Bay (NV); Sur place; USD 52 000 - 78 000; Plein temps

Avantages offerts par ce poste

Medical, vision, and dental coverage

Life and disability insurance

401K employer match and pension

Tuition assistance

Hybrid on-site model

Free on-site parking

Well-being center (on-site/virtual)

On-site team activities

Shuffled board games on campus

Résumé du poste

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes and reconciliations. You will interact with members, agents and internal teams via phone, email or written correspondence within set turnaround times.

The role requires strong customer service skills, knowledge of healthcare regulations, and the ability to explain administrative guidelines.

Qualifications

• High School diploma or GED required; 2+ years in accounting/finance/bookkeeping or enrollment processing; health or insurance industry experience beneficial.

Responsabilités

• Provide technical support to assigned teams by researching/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, accuracy and timeliness.
• Represent department on cross-functional teams and meet with external customers as required.
• Review procedures and training material for in-team and strategic partner training to improve efficiency.
• Complete special projects and other duties as assigned.
• Track audit findings and ensure action plans are completed in a timely and accurate manner.
• Update eligibility, enrollment and/or billing of accounts.
• Contact customers or Producer agents for enrollment clarification and guidance on administrative/regulatory rules.
• Meet or exceed department production and quality standards and stay current on policies and procedures.
• Educate agents and members on general membership and billing processes; include web portal usage and regulation interpretation.

Connaissances

Customer service

Auditing

Research

Communication

Policy interpretation

Teamwork

Formation

High School diploma or GED

Description du poste

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes and reconciliations. You will interact with members, agents and internal teams via phone, email or written correspondence within set turnaround times.

The role requires strong customer service skills, knowledge of healthcare regulations, and the ability to explain administrative guidelines.