Membership Representative

Blue Cross and Blue Shield of North Carolina; North Carolina; Hybrid; USD 42,000 - 67,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k match

Paid Time Off (PTO)

Parental leave and surrogacy support

Tuition reimbursement

Hybrid-flex / Remote Flex work options

Job summary

Blue Cross and Blue Shield of North Carolina in Durham is seeking an Enrollment Specialist to administer member and group enrollment, eligibility, and membership activities to ensure accurate records across health plan products.

You will perform enrollment transactions, resolve eligibility and billing issues, and support members, agents, and benefits administrators while maintaining data integrity and complying with regulations.

Qualifications

• High school diploma or GED is required.
• 0-2 years of experience in related field.

Responsibilities

• Enroll and renew groups and members, maintaining accurate membership records including additions, deletions, changes, and terminations for the health plans.
• Perform standard and moderately complex group level/or member-level enrollment for medical and ancillary products per procedures.
• Maintain accurate, timely membership and eligibility records across multiple systems, ensuring data integrity and compliance.
• Address eligibility issues by applying applicable federal and state regulations and internal/external governance requirements.
• Process billing inquiries and reconciliation activities, including researching discrepancies and initiating corrections.
• Research and respond to enrollment errors via telephone or written communication, documenting issues and actions.
• Receive and place calls to answer questions, obtain information, and resolve inquiries related to membership, enrollment, records, and contracts.
• Support agents, benefits administrators, and members with general billing and enrollment questions.
• Process back-end error reports for electronic enrollment reports, ensuring timely identification, resolution, and documentation of discrepancies.

Skills

Accounts Payable Process

Answering Telephones

Benefits Administration

Billing

Billing Process

Billing Reconciliation

Customer Care

Customer Service

Data Entry

Email Management

Enrollment Management

Health Insurance

Insurance Administration

Member Retention

Relationship Building

Sales

Student Enrollment

Education

High school diploma or GED

Job description

Job Description

Responsible for administering member and group enrollment, eligibility, and membership activities to ensure accurate and compliant membership records across health plan products. Performs enrollment transactions, resolves eligibility and billing issues, researches and corrects discrepancies, and provides support to members, agents, and benefits administrators. Maintains data integrity across multiple systems while ensuring adherence to regulatory requirements, operational procedures, and service standards. Facilitates timely resolution of enrollment, billing, and membership inquiries to support an accurate and positive member experience.

What You’ll Do

• Enroll and renew groups and members, and maintain accurate membership records, including additions, deletions, and changes. and terminations for the health plans.
• Perform standard and moderately complex group level/or member-level enrollment for medical and ancillary products in accordance with established procedures.
• Maintain accurate, timely membership and eligibility records across multiple systems, ensuring data integrity and compliance.
• Address eligibility issues by applying applicable federal and state regulations and internal and external governance requirements.
• Process billing inquiries and reconciliation activities, including researching billing discrepancies and initiating corrections or reverse transactions as needed.
• Research and respond to enrollment errors via telephone or written communication, clearly documenting issues, corrective actions taken, and applicable policies or procedures.
• Receive and place calls to respond to questions, obtain information, and resolve inquiries related to membership, enrollment, group and individual records, and contracts.
• Support agents, benefits administrators, and members with general billing and enrollment questions.
• Process back-end error reports for electronic enrollment reports, ensuring timely identification, resolution, and documentation of discrepancies.

What You Bring

• High school diploma or GED
• 0-2 years of experience in related field

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused. In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter. Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance.

$41,600.00 - $66,561.00

Skills

• Accounts Payable Process
• Answering Telephones
• Benefits Administration
• Billing
• Billing Process
• Billing Reconciliation
• Customer Care
• Customer Service
• Data Entry
• Email Management
• Enrollment Management
• Health Insurance
• Insurance Administration
• Member Retention
• Relationship Building
• Sales
• Student Enrollment

About Us

It’s an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail].

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.