Remote Enrollment Oversight & Quality Specialist

Premera Blue Cross; Central City (KY); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Total rewards program

On-site parking benefits

Wellness programs

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist as a remote, telecommuter position. You will oversee moderate to complex enrollment, eligibility, billing changes and reconciliation, while providing exceptional customer service via phone, email, or written correspondence within set timelines.

You will support audits, update procedures, and coordinate with strategic implementation partners to improve efficiency and accuracy in enrollment processes.

Qualifications

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

Responsibilities

• Review plan provisions and apply rules for Individual or Group enrollment scenarios; follow federal/state guidelines.
• Provide technical support to teams/partners by researching issues related to processing, systems, and software applications.
• Serve as a resource for customers by researching complex system issues impacting eligibility; escalate as needed.
• Conduct performance audits to ensure transaction compliance, accuracy and timeliness; identify process improvements.
• Represent department on cross-functional teams and meet with external customers as required.
• Review procedures and training materials to outline improvements for efficiency with training and partner teams.
• Provide back-up support across Enrollment & Billing; complete special projects as assigned.
• Track audit findings and action plans with partners to ensure timely completion.
• Process plan changes, dependent add-ons, transfers and more complex enrollments; update eligibility/billing.
• Contact customers/agents for enrollment clarification and provide administrative/regulatory guidelines.
• Meet or exceed department production and quality standards; stay current on policies and procedures.
• Educate agents and members on membership and billing processes; may include Web portal usage and regulations interpretation.
• Perform other duties as assigned.

Education

High School diploma or GED

Associate’s degree in accounting

Previous customer service experience

Health or insurance industry experience

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist as a remote, telecommuter position. You will oversee moderate to complex enrollment, eligibility, billing changes and reconciliation, while providing exceptional customer service via phone, email, or written correspondence within set timelines.

You will support audits, update procedures, and coordinate with strategic implementation partners to improve efficiency and accuracy in enrollment processes.