Enrollment Quality & Compliance Specialist

Premera Blue Cross; Idaho; Remote; USD 42,000 - 62,000; Full time

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to manage complex enrollment, eligibility, billing changes and audits, using multiple systems. The role requires strong customer service and the ability to explain regulatory guidelines to members and agents.

This telecommuter position supports business operations during the department's 7:00 AM to 5:00 PM PT window with occasional late shifts; collaboration with internal teams and implementation partners is essential.

Qualifications

• High School diploma or GED required.
• At least 2 years of accounting/finance or enrollment processing experience.
• Preferred: Associate's degree in accounting.
• Preferred: customer service experience.
• Preferred: health or insurance industry experience.

Responsibilities

• Review plan provisions and apply enrollment rules while following state and federal guidelines.
• Provide technical support to teams and implementation partners for processing issues.
• Research complex systems issues impacting member eligibility and determine actions.
• Conduct performance audits to ensure accuracy and timelines, and suggest improvements.
• Coordinate with cross-functional teams and external customers as required.

Skills

Customer service experience

Enrollment processing

Accounting/finance/bookkeeping

Education

High School diploma or GED

Associate’s degree in accounting

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to manage complex enrollment, eligibility, billing changes and audits, using multiple systems. The role requires strong customer service and the ability to explain regulatory guidelines to members and agents.

This telecommuter position supports business operations during the department's 7:00 AM to 5:00 PM PT window with occasional late shifts; collaboration with internal teams and implementation partners is essential.