Remote Enrollment & Quality Audit Specialist

Premera Blue Cross; Colorado; Remote; USD 42.000 - 62.000; Vollzeit

Zusammenfassung

Premera Blue Cross in Colorado is seeking an Enrollment Oversight and Quality Specialist to manage moderate to complex enrollment, eligibility, billing changes and reconciliation, while delivering superior customer service via phone, email, or written correspondence within established department turnaround times.

The role will provide support for audits, procedures, and efficiency improvements, coordinating with strategic implementation partners and internal teams.

Qualifikationen

• High School diploma or GED required.
• Two years in accounting/finance or enrollment processing experience.
• Health or insurance industry experience preferred.

Aufgaben

• Review plan provisions and apply enrollment rules per state and federal guidelines.
• Provide technical support to teams/partners for processing issues.
• Research complex system issues impacting member eligibility and escalate as needed.
• Conduct performance audits to ensure accuracy and timeliness.
• Represent department on cross-functional teams and meet with external customers as required.
• Review procedures and training materials to outline improvements for efficiency.
• Provide back-up across Enrollment & Billing and complete special projects as assigned.
• Track audit findings and ensure action plans are completed in a timely manner.
• Process plan changes, dependent add-ons, transfers, and enrollment updates.
• Contact customers or Producer agents for enrollment clarification and regulatory guidance.

Kenntnisse

Customer service

Ausbildung

High School diploma or GED

Jobbeschreibung

Premera Blue Cross in Colorado is seeking an Enrollment Oversight and Quality Specialist to manage moderate to complex enrollment, eligibility, billing changes and reconciliation, while delivering superior customer service via phone, email, or written correspondence within established department turnaround times.

The role will provide support for audits, procedures, and efficiency improvements, coordinating with strategic implementation partners and internal teams.