Remote Enrollment & Quality Assurance Specialist

Premera Blue Cross; Salem (NH); Remote; USD 42,000 - 71,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Life and disability insurance

401K employer match

Job summary

Premera Blue Cross seeks an Enrollment Oversight and Quality Specialist to manage complex enrollment, eligibility, billing changes, and audits. You will research issues, apply federal/state guidelines, and support partners, with a focus on accuracy and timely responses to members and producers.

The role requires coordinating audits, updating procedures, and educating agents and members on membership and billing processes, within a hybrid/telecommuter setup.

Qualifications

• High School diploma or GED is required.
• Two years accounting/finance/bookkeeping 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 for enrollment scenarios according to rules and guidelines.
• Provide technical support to teams and implementation partners for processing issues.
• Research complex systems issues affecting member eligibility and advise action.
• Conduct performance audits to ensure compliance and improve efficiency.
• Represent department on cross-functional teams and with external customers.
• Train and update team and partner staff on procedures for efficiency improvements.
• Provide back-up support across Enrollment & Billing as needed.
• Track audit findings and follow action plans to ensure completion.

Skills

Customer service experience

Health or insurance industry

Attention to detail

Education

Associate’s degree in accounting

Job description

Premera Blue Cross seeks an Enrollment Oversight and Quality Specialist to manage complex enrollment, eligibility, billing changes, and audits. You will research issues, apply federal/state guidelines, and support partners, with a focus on accuracy and timely responses to members and producers.

The role requires coordinating audits, updating procedures, and educating agents and members on membership and billing processes, within a hybrid/telecommuter setup.