Quality Assurance Officers

Premera Blue Cross; Saint Paul (MN); Hybrid; USD 50,000 - 70,000; Full time

Benefits offered by this job

Medical, vision, dental coverage

401K employer match

Pension plan after 3 years of service

Tuition assistance for undergrad and +

Hybrid work model

On-site parking

Job summary

Premera is seeking an Enrollment Oversight and Quality Specialist to perform complex enrollment, eligibility, billing changes and reconciliations across multiple systems. You will interact with members, producers and internal teams by phone, email, or written correspondence within standard turnaround times.

The role emphasizes strong customer service, knowledge of healthcare regulations, and participation in audits and process improvements.

Qualifications

• Minimum two years accounting/finance or enrollment processing experience.
• High School diploma or GED.
• Exceptional customer service and ability to explain administrative/regulatory guidelines to members/agents.

Responsibilities

• Perform enrollment, eligibility, billing changes and reconciliation.
• Audit procedures and tracking with partners to improve efficiency.
• Assist customers via phone, email or written correspondence within department timelines.
• Represent department on cross-functional teams and liaise with external customers as required.
• Update eligibility, enrollment and/or billing of accounts and respond to information requests.
• Educate agents and members on membership and billing rules; include portal usage and regulations.

Skills

Customer service

Communication

Cross-functional collaboration

Problem solving

Education

High School diploma or GED

Job description

Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

By investing in our employees and fostering a culture of collaboration and continuous development, we're able to better serve our customers. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:

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The

Enrollment Oversight and Quality Specialist

will perform moderate to complex enrollment, eligibility, billing changes and reconciliation, and account research using a variety of methods, systems and platforms. This role is expected to have exceptional customer service skills and interact with internal and external customers in a timely and professional manner via phone, email or written correspondence within established department turnaround times. Must be able to thoroughly explain administrative and regulatory guidelines, their impact and offer alternatives to our members/agents. This role will include the development, maintenance and tracking of related audits, procedures, and efficiency work in team and as it relates to our strategic implementation partners.

Candidates must be available to support business operations during the department's 7:00 AM to 5:00 PM PT coverage window. This role also requires participation in a late-shift rotation, typically one day per week, with occasional additional coverage based on business needs. Late-shift hours are 8:30 AM to 5:00 PM PT.

Provides technical support to assigned teams/strategic implementation partners by researching and/or troubleshooting issues related to processing, system, and software applications.

• Serves 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. Identifies, recommends and implements process improvements.
• Represents department on cross-functional teams and meets with external customers as required.
• Regularly reviews procedures and training material for in-team and strategic implementation partner training, through partnership with the training and quality coaching teams, to outline and implement improvements for increased efficiency.
• complete special projects and perform other duties as assigned.
• Tracks, monitors, updates, and follows-up with strategic implementation partner on audit findings, action plans, and information requests to ensure each item on the action plan is completed in a timely and accurate manner.
• Update eligibility, enrollment and/or billing of accounts.
• Contact customers or Producer agents for enrollment clarification and/or to provide administrative/regulatory guidelines. This may include creating written correspondence regarding complex billing and enrollment issues.
• Must meet or exceed department production and quality standards and remain current on company/departmental policies and procedures.
• Educate agents and members on general membership and billing processes and administrative rules; may include Web portal usage and contract or regulation interpretation.

High School diploma or GED. (Minimum of two (2) years of accounting/finance/bookkeeping experience or two (2) years enrollment processing experience. (Previous customer service experience. (Health or insurance industry experience. (Expertise in complex enrollment, eligibility, billing, and reconciliation processes

Experience conducting audits and improving quality and efficiency

Increased knowledge of healthcare regulations and administrative guidelines

Collaboration experience with customers, partners, and cross-functional teams

The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation:

• This role requires the ability to use a keyboard and to communicate clearly and understandably in person and over the telephone.

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• We have tuition assistance for both undergraduate and graduate degrees.
• For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
• Free convenient on-site parking.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Challenge someone to a game of shuffleboard or ping pong while on campus.

Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at or via phone at.

we generally target up to and around the midpoint of the range.