Enrollment Quality & Compliance Specialist

Premera Blue Cross; South Dakota Park (SD); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

On-site parking

Tuition assistance

Pension plan

401K match

Health coverage

On-site gym

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes, and reconciliation with a focus on accuracy and service quality. You will support strategic implementation partners and educate members and agents on enrollment processes and regulations.

The role requires availability within a 7:00 AM–5:00 PM PT window, with one weekly late shift and potential additional coverage.

Qualifications

• Exceptional customer service skills and ability to interact with internal and external customers.
• Experience conducting audits and improving quality and efficiency.
• Knowledge of healthcare regulations and administrative guidelines.

Responsibilities

• Provide technical support to assigned teams and partners by researching issues related to processing, systems, and software applications.
• Research complex systems issues impacting eligibility and determine appropriate action; conduct performance audits.
• Represent department on cross-functional teams and meet with external customers as required.
• Update procedures and training materials to improve efficiency in team and partner training.
• Track audit findings and ensure action plans are completed in a timely manner.
• Educate agents and members on membership and billing processes and regulatory guidance.

Skills

Customer service

Problem solving

Audits

Cross-functional teamwork

Education

High School diploma or GED

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes, and reconciliation with a focus on accuracy and service quality. You will support strategic implementation partners and educate members and agents on enrollment processes and regulations.

The role requires availability within a 7:00 AM–5:00 PM PT window, with one weekly late shift and potential additional coverage.