Remote Enrollment Quality & Compliance Specialist

Premera; Washington; Hybrid; USD 42,000 - 71,000; Full time

Job summary

Premera is hiring an Enrollment Oversight and Quality Specialist to perform moderate to complex enrollment, eligibility, billing changes and reconciliation, with strong customer service and clear communication with members, agents, and internal teams.

You will review plan provisions, apply federal and state guidelines, conduct audits, and support improvement of enrollment and billing processes while meeting quality standards in a fast-paced health‑care environment.

Qualifications

• High School diploma or GED required.
• Minimum of two (2) years of accounting/finance/budgeting or enrollment processing experience.
• 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 Individual or Group enrollment scenarios with applicable federal/state guidelines.
• Provide technical support to teams by researching and troubleshooting issues related to processing, systems, and software applications.
• Act as a resource for customers by researching complex system issues affecting eligibility and determining appropriate actions.
• Conduct performance audits to ensure transaction accuracy and timeliness; identify and implement process improvements.
• Educate agents and members on membership and billing processes and administrative rules; may include Web portal usage.

Skills

Customer service

Research

Troubleshooting

Communication

Attention to detail

Education

High School diploma or GED

Associate’s degree in accounting

Tools

Enrollment processing systems

Billing systems

Job description

Premera is hiring an Enrollment Oversight and Quality Specialist to perform moderate to complex enrollment, eligibility, billing changes and reconciliation, with strong customer service and clear communication with members, agents, and internal teams.

You will review plan provisions, apply federal and state guidelines, conduct audits, and support improvement of enrollment and billing processes while meeting quality standards in a fast-paced health‑care environment.