Enrollment Quality & Compliance Specialist

Premera Blue Cross; South Dakota; On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical coverage

Vision coverage

Dental coverage

401K employer match

Pension plan

Tuition assistance

On-site parking

Well-being center access

Campus events

Job summary

Premera Blue Cross is hiring an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes, and account research across multiple platforms. You will support internal teams and external customers by explaining regulatory guidelines and offering alternatives, while contributing to audits and efficiency initiatives.

The role requires handling early morning to late afternoon PT coverage, occasional late shifts, and collaboration with cross-functional

Qualifications

• High School diploma or GED.
• 2+ years accounting/finance/bookkeeping or enrollment processing experience.
• Previous customer service experience.
• Healthcare/insurance industry knowledge and complex enrollment proficiency.

Responsibilities

• Provide technical support to teams and strategic partners by researching issues in processing, systems and software.
• Research complex system issues affecting member eligibility and determine appropriate actions.
• Conduct performance audits to ensure transaction compliance, accuracy and timeliness.
• Represent department on cross-functional teams and meet with external customers as required.
• Review procedures and training material to improve efficiency with internal and partner teams.
• Update eligibility, enrollment and/or billing information for accounts.
• Educate agents and members on membership, billing processes and regulatory guidelines.

Skills

Customer service

Audit processes

Enrollment processing

Regulatory knowledge

Education

High School diploma or GED

Job description

Premera Blue Cross is hiring an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes, and account research across multiple platforms. You will support internal teams and external customers by explaining regulatory guidelines and offering alternatives, while contributing to audits and efficiency initiatives.

The role requires handling early morning to late afternoon PT coverage, occasional late shifts, and collaboration with cross-functional