Enrollment Quality & Compliance Specialist

Premera Blue Cross; Utah; On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

401(k) employer match

Tuition assistance program

On-site parking and campus facilities

Well-being center and fitness programs

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist in Utah to manage complex enrollment changes, eligibility reviews, and billing reconciliations. The role emphasizes accuracy, regulatory understanding, and delivering clear guidance to members and agents.

The position requires strong auditing skills and collaboration with internal teams and strategic partners to improve processes and ensure compliance with healthcare regulations.

Qualifications

• Experience with enrollment, eligibility, billing changes and reconciliation processes.
• Ability to conduct audits and improve quality and efficiency.
• Strong customer service skills with ability to explain guidelines clearly.

Responsibilities

• Research and troubleshoot issues related to processing, systems, and software applications.
• Audit findings tracking and action planning with internal/external partners.
• Educate agents and members on enrollment processes and administrative rules.
• Support cross-functional teams and participation in special projects as needed.
• Update eligibility, enrollment and billing information and respond to inquiries.

Skills

Enrollment processing

Audit & quality improvement

Customer service

Regulatory guidance

Education

High School diploma or GED

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist in Utah to manage complex enrollment changes, eligibility reviews, and billing reconciliations. The role emphasizes accuracy, regulatory understanding, and delivering clear guidance to members and agents.

The position requires strong auditing skills and collaboration with internal teams and strategic partners to improve processes and ensure compliance with healthcare regulations.