Enrollment Quality & Compliance Specialist

Premera Blue Cross; Utah; On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Health insurance

401(k) employer match

On-site parking

On-site fitness center

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to handle complex enrollment, eligibility, billing changes and reconciliations across systems. You will interact with members and agents, explain regulatory guidelines and drive process improvements within ongoing audits.

Responsibilities include supporting business operations during the 7:00 AM–5:00 PM PT window, participating in late shifts, and collaborating with cross-functional partners to ensure accurate

Qualifications

• Two years of accounting/finance/bookkeeping or enrollment processing experience.
• Experience with audits and quality improvement.
• Healthcare regulations knowledge is a plus.

Responsibilities

• Provide technical support to teams/partners by researching issues related to processing, system and software applications.
• Investigate complex system issues affecting member eligibility and determine actions.
• Conduct performance audits to ensure compliance, accuracy and timeliness; suggest improvements.
• Represent department on cross-functional teams and meet with external customers as required.
• Update eligibility, enrollment and/or billing of accounts; communicate guidelines to members or agents.
• Support department production and quality standards; stay current on policies.
• Educate agents and members on membership and billing processes, including portal usage.

Skills

Enrollment processing

Audits

Customer service

Regulatory guidelines

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 reconciliations across systems. You will interact with members and agents, explain regulatory guidelines and drive process improvements within ongoing audits.

Responsibilities include supporting business operations during the 7:00 AM–5:00 PM PT window, participating in late shifts, and collaborating with cross-functional partners to ensure accurate