Enrollment Quality & Compliance Specialist

Premera; United States; Remote; USD 42,000 - 62,000; Full time

Job summary

Premera is seeking an Enrollment Oversight and Quality Specialist to review plan provisions, apply enrollment rules, and support audits across Individual and Group enrollment scenarios. You’ll troubleshoot processing issues, assist internal teams, and explain regulatory guidelines to members and producers.

We value strong customer service, attention to detail, and thorough knowledge of healthcare regulations.

Qualifications

• High School diploma or GED (Required).
• Minimum of two (2) years of accounting/finance/bookkeeping experience or two (2) years enrollment processing experience.
• Associate’s degree in accounting (Preferred).
• Previous customer service experience (Preferred).
• Health or insurance industry experience (Preferred).

Responsibilities

• Review plan provisions and apply specific rules inherent to Individual or Group enrollment scenarios.
• Provide technical support to assigned teams/partners by researching/troubleshooting issues related to processing, system, and software applications.
• Serve as a resource for customers by researching complex systems issues impacting member eligibility and determining appropriate course of action.
• Conduct performance audits to ensure transaction compliance, accuracy and timeliness.
• Represent department on cross-functional teams and meet with external customers as required.
• Regularly review procedures and training material to outline and implement improvements for increased efficiency.
• Provide back-up and peak-load assistance across Enrollment & Billing; complete special projects and other duties as assigned.
• Track, monitor, and follow-up with partners on audit findings and action plans to ensure timely completion.
• Process plan changes, dependent add-ons, direct transfers, and other challenging enrollments; update eligibility, enrollment and/or billing of accounts.
• Contact customers or Producer agents for enrollment clarification and/or to provide administrative/regulatory guidelines; may include written correspondence about complex billing/enrollment issues.
• Meet or exceed department production and quality standards and stay current on policies and procedures.
• Educate agents and members on general membership and billing processes; may include Web portal usage and regulation interpretation.
• Perform other duties as assigned.

Skills

Customer service

Enrollment processing

Accounting

Finance

Education

High School diploma or GED

Associate’s degree in accounting

Job description

Premera is seeking an Enrollment Oversight and Quality Specialist to review plan provisions, apply enrollment rules, and support audits across Individual and Group enrollment scenarios. You’ll troubleshoot processing issues, assist internal teams, and explain regulatory guidelines to members and producers.

We value strong customer service, attention to detail, and thorough knowledge of healthcare regulations.