[Hiring] Enrollment Oversight & Quality Specialist @Premera Blue Cross

Role Description

Are you ready to make a real difference in the world of enrollment and quality assurance? Step into the pivotal role of Enrollment Oversight and Quality Specialist , where your expertise will drive accuracy, compliance, and customer satisfaction at every turn! In this fast-paced position, you’ll tackle complex enrollment scenarios, collaborate with strategic partners, and champion process improvements that shape the future of our organization.

If you thrive on solving challenges, delivering exceptional service, and being a trusted resource for both internal teams and external customers, this is your opportunity to shine. Join us and become the backbone of our enrollment operations—where every detail matters and your contributions truly count!

The Enrollment Oversight and Quality Specialist position will perform moderate to complex enrollment, eligibility, billing changes and reconciliation, and account research using a variety of methods, systems and platforms. This role is expected to have exceptional customer service skills and interact with internal and external customers in a timely and professional manner via phone, email or written correspondence within established department turnaround times.

Must be able to thoroughly explain administrative and regulatory guidelines, their impact and offer alternatives to our members/agents. This position will provide support and coordination to assist in the management and improvement of assigned audit processes. This role will include the development, maintenance and tracking of related audits, procedures, and efficiency work in team and as it relates to our strategic implementation partners.

What you will do:

• Responsible for reviewing plan provisions and applying specific rules inherent to Individual or Group enrollment scenarios.
• Apply contractual, state and federal guidelines as appropriate, ensuring work is in compliance with federal and state regulations.
• Provide technical support to assigned teams/strategic implementation partners by researching and/or troubleshooting issues related to processing, system, and software applications.
• Serve as a resource for customers by researching complex systems issues impacting member eligibility and determining appropriate course of action.
• Escalate issues or concerns to ensure desired results.
• Conduct performance audits to ensure transaction compliance, accuracy and timeliness.
• Identify, recommend and implement process improvements.
• Represent department on cross-functional teams and meet with external customers as required.
• Regularly review procedures and training material for in-team and strategic implementation partner training.
• Provide back-up and peak-load assistance across Enrollment & Billing as needed.
• Track, monitor, update, and follow-up with strategic implementation partner on audit findings, action plans, and information requests.
• Process plan changes, dependent add-ons, direct transfers, transfer accumulators and more challenging types of enrollments.
• Contact customers or Producer agents for enrollment clarification and/or to provide administrative/regulatory guidelines.
• Must meet or exceed department production and quality standards and remain current on company/departmental policies and procedures.
• Educate agents and members on general membership and billing processes and administrative rules.
• Perform other duties as assigned.

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.
• Previous customer service experience.
• Health or insurance industry experience.

Requirements

• Regulatory and Compliance Expertise: Hands-on experience applying contractual, state, and federal guidelines to enrollment scenarios.
• Technical Troubleshooting and Systems Analysis: Providing technical support, researching and resolving issues related to processing, system, and software applications.
• Audit and Process Improvement: Conducting performance audits, identifying compliance gaps, and recommending process improvements.
• Customer Service and Communication: Strengthening customer service and communication skills through interaction with internal and external customers.
• Cross-functional Collaboration and Training: Working with cross-functional teams, strategic partners, and participating in training initiatives.

Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources.
• Generous paid time off to reenergize.
• Tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries and team accomplishments.
• Flexible on-campus model for hybrid employees with access to on-site resources.
• Commuter perks and free convenient on-site parking.
• Subsidized on-campus cafes.
• Engaging on-site activities such as health and wellness events.
• Complementary fitness & well-being center offering in-person and virtual workouts.