Remote Enrollment Oversight & Quality Specialist

Premera Blue Cross; Orangeburg (SC); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

401K employer match

Pension plan

Tuition assistance

On-site parking

Commuter perks

Wellness programs

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to manage enrollment, eligibility, billing changes, and audits across multiple platforms. You will provide exceptional customer service via phone, email, or written correspondence, explain regulatory guidelines, and support strategic implementation partners.

The role requires strong attention to detail, ability to work within the department’s turnaround times, and collaboration with cross-functional teams to improve

Qualifications

• High School diploma or GED (Required).
• Minimum of two years of accounting/finance/bookkeeping experience or two 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 enrollment scenarios under federal/state guidelines.
• Provide technical support to teams/partners researching issues in processing systems.
• Assist customers by researching complex eligibility issues and determine actions.
• Conduct performance audits to ensure accuracy and timeliness; identify improvements.
• Represent department on cross-functional teams and meet with external customers as required.
• Review procedures and training materials to improve efficiency for teams and partners.
• Provide back-up support across Enrollment & Billing; participate in special projects.
• Track audit findings and action plans to ensure timely completion.
• Process plan changes, dependent add-ons, transfers and challenging enrollments; update eligibility/billing accordingly.
• Contact customers or Producer agents for enrollment clarification and guidance on regulatory rules.
• Meet or exceed department production and quality standards; stay current on policies.
• Educate agents and members on membership and billing processes; may include Web portal usage.
• Perform other duties as assigned.

Skills

Customer service experience

Enrollment processing

Auditing / QA

Research / Troubleshooting

Regulatory guidelines knowledge

Education

High School diploma or GED

Associate’s degree in accounting

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to manage enrollment, eligibility, billing changes, and audits across multiple platforms. You will provide exceptional customer service via phone, email, or written correspondence, explain regulatory guidelines, and support strategic implementation partners.

The role requires strong attention to detail, ability to work within the department’s turnaround times, and collaboration with cross-functional teams to improve