Enrollment Quality & Compliance Specialist

Premera Blue Cross; Hydaburg (AK); Sur place; USD 55 000 - 75 000; Plein temps

Avantages offerts par ce poste

Medical, vision, and dental coverage

401K employer match

Pension plan vested after 3 years

Tuition assistance

On-site parking

Résumé du poste

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform enrollment, eligibility, billing changes, and reconciliation with strong customer service. You will audit processes, educate members and agents, and support cross-functional teams.

The role requires attention to regulatory guidelines and the ability to explain complex rules clearly. Position supports a 7:00 AM–5:00 PM PT coverage window with a late-shift rotation.

Qualifications

• High School diploma or GED; 2 years accounting/finance/billing or enrollment processing experience.
• Health or insurance industry experience.
• Experience conducting audits and improving quality and efficiency.

Responsabilités

• Provide technical support for processing, systems, and software applications.
• Research complex eligibility issues and determine appropriate actions; conduct performance audits.
• Represent department on cross-functional teams and meet with external customers.
• Review procedures and training materials and implement improvements with training teams.
• Complete special projects and other duties as assigned.
• Track audit findings and ensure timely action plans.
• Update eligibility, enrollment, and billing records.
• Contact customers or agents for enrollment clarification and guidance.
• Meet department production and quality standards; stay current on policies.
• Educate agents and members on membership and billing processes and portal usage.

Connaissances

Customer service

Audits

Communication

Formation

High School diploma or GED

Accounting/finance experience

Enrollment processing experience

Health/insurance industry experience

Description du poste

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform enrollment, eligibility, billing changes, and reconciliation with strong customer service. You will audit processes, educate members and agents, and support cross-functional teams.

The role requires attention to regulatory guidelines and the ability to explain complex rules clearly. Position supports a 7:00 AM–5:00 PM PT coverage window with a late-shift rotation.