Remote Enrollment Quality & Audits Specialist

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

Benefits offered by this job

Commuter perks

Tuition assistance

On-site parking

Job summary

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to support complex enrollment, eligibility, billing changes, and audit processes. The role involves reviewing plan provisions, researching issues, and coordinating with internal teams and external partners to ensure compliance and timely actions.

The position requires strong customer service skills, experience in enrollment processing or accounting, and a background in health or insurance.

Qualifications

• Two years of accounting/finance or enrollment processing experience.
• Customer service experience.
• Health or insurance industry experience preferred.

Responsibilities

• Review plan provisions and apply rules for enrollment scenarios.
• Provide technical support to assigned teams/partners on processing, system, and software applications.
• Research complex systems issues affecting member eligibility and determine actions.
• Conduct performance audits to ensure transaction compliance and identify improvements.
• Represent department on cross-functional teams and engage external customers.
• Review procedures and training materials to improve partner training and efficiency.
• Provide back-up support across Enrollment & Billing; handle special projects.
• Track audit findings with partners and ensure timely action plans.
• Process plan changes, dependent add-ons, transfers, and enrollment updates.
• Contact customers or producers for enrollment clarification and to explain guidelines.
• Meet or exceed department production and quality standards; stay current on policies.
• Educate agents and members on membership and billing processes; web portal usage as needed.
• Perform other duties as assigned.

Skills

Enrollment processing

Customer service

Accounting/finance

Health/insurance experience

Education

Associate’s degree in accounting

Job description

Premera Blue Cross is seeking an Enrollment Oversight and Quality Specialist to support complex enrollment, eligibility, billing changes, and audit processes. The role involves reviewing plan provisions, researching issues, and coordinating with internal teams and external partners to ensure compliance and timely actions.

The position requires strong customer service skills, experience in enrollment processing or accounting, and a background in health or insurance.