Remote Enrollment Quality & Compliance Specialist

Premera Blue Cross; Clayton (NM); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

On-site parking

Tuition assistance

Commuter perks

Wellness center access

Job summary

Premera Blue Cross in United States is seeking an Enrollment Oversight and Quality Specialist. The role handles enrollment, eligibility, billing changes, and audits while delivering exceptional customer service to members and agents via phone, email, or written communication.

Candidates should be prepared to work within department hours and participate in occasional late shifts. This position emphasizes regulatory alignment, process improvements, and cross-functional collaboration across

Qualifications

• High School diploma or GED. (Required)
• Minimum of two (2) years of accounting/finance/bookkeeping experience or two (2) 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 applicable guidelines.
• Provide technical support to assigned teams/partners by researching issues with processing, systems, and software.
• Research complex systems issues impacting member eligibility and determine course of action.
• Conduct performance audits to ensure transaction compliance, 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 support across Enrollment & Billing and complete special projects.
• Track and follow up on audit findings and action plans to ensure timely completion.

Skills

Enrollment processing

Customer service

Accounting/Finance

Auditing

Problem solving

Education

Associate degree in accounting

High School diploma or GED

Job description

Premera Blue Cross in United States is seeking an Enrollment Oversight and Quality Specialist. The role handles enrollment, eligibility, billing changes, and audits while delivering exceptional customer service to members and agents via phone, email, or written communication.

Candidates should be prepared to work within department hours and participate in occasional late shifts. This position emphasizes regulatory alignment, process improvements, and cross-functional collaboration across