Remote Enrollment Quality & Audit Specialist

Premera Blue Cross; Kansas; Remote; USD 42,000 - 62,000; Full time

Job summary

Premera Blue Cross in the United States seeks an Enrollment Oversight and Quality Specialist to manage moderate to complex enrollment, eligibility, billing changes and reconciliation while delivering exceptional member service via phone, email, or written correspondence.

This role provides support and coordination to assist in audits and improves related processes within our team and with strategic partners.

Qualifications

• High School diploma or GED is required.
• Minimum of two years in accounting/finance or enrollment processing.
• Associate 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, following federal and state guidelines.
• Provide technical support to teams and implementation partners by researching issues.
• Research complex systems issues impacting member eligibility and determine corrective actions.
• Conduct performance audits to ensure compliance, accuracy and timeliness.
• Represent the department on cross-functional teams and meet external customers as required.
• Review procedures and training materials to outline improvements for efficiency.

Skills

Customer service experience

Health or insurance industry

Enrollment processing

Education

Associate’s degree in accounting

High School diploma or GED

Job description

Premera Blue Cross in the United States seeks an Enrollment Oversight and Quality Specialist to manage moderate to complex enrollment, eligibility, billing changes and reconciliation while delivering exceptional member service via phone, email, or written correspondence.

This role provides support and coordination to assist in audits and improves related processes within our team and with strategic partners.