Enrollment Quality & Compliance Specialist

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

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to perform moderate to complex enrollment, eligibility, billing changes and reconciliation, and account research. This remote role supports 7:00 AM–5:00 PM PT with one late shift per week, involving phone, email, or written correspondence and adherence to regulatory guidelines.

You will review plan provisions, provide technical support to teams and implementation partners, and conduct audits to improve efficiency.

Qualifications

• High School diploma or GED (Required).
• Minimum of two years accounting/finance/bookkeeping experience or enrollment processing experience (Required).
• Associate’s degree in accounting (Preferred).
• Previous customer service experience (Preferred).
• Health or insurance industry experience (Preferred).

Responsibilities

• Review enrollment provisions and apply rules for Individual or Group enrollment, following regulations.
• Provide technical support to teams and implementation partners troubleshooting processing issues.
• Research complex systems issues affecting eligibility; escalate as needed.
• Conduct performance audits to ensure accuracy and improve processes.
• Coordinate with cross-functional teams and external customers as required.
• Maintain and update training materials and procedures with the training/quality teams.
• Provide back-up across Enrollment & Billing; complete special projects as assigned.
• Monitor audit findings and ensure action plans are completed in a timely manner.
• Process plan changes, add-ons, transfers, and other enrollment types; update eligibility/billing.
• Contact customers or producers for enrollment clarification and guidance; prepare written correspondence.
• Meet production and quality standards; stay current on policies.
• Educate members on membership and billing processes; portal usage.
• Perform other duties as assigned.

Skills

Enrollment processing experience

Accounting/finance experience

Customer service experience

Education

Associate’s 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, and account research. This remote role supports 7:00 AM–5:00 PM PT with one late shift per week, involving phone, email, or written correspondence and adherence to regulatory guidelines.

You will review plan provisions, provide technical support to teams and implementation partners, and conduct audits to improve efficiency.