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

Role Description

The Enrollment Oversight and Quality Specialist 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.

Candidates must be available to support business operations during the department's 7:00 AM to 5:00 PM PT coverage window. This role also requires participation in a late-shift rotation, typically one day per week, with occasional additional coverage based on business needs. Late-shift hours are 8:30 AM to 5:00 PM PT.

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 follows federal and state regulations.
• Provides technical support to assigned teams/strategic implementation partners by researching and/or troubleshooting issues related to processing, system, and software applications.
• Serves 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. Identifies, recommends and implements process improvements.
• Represents department on cross-functional teams and meets with external customers as required.
• Regularly reviews procedures and training material for in-team and strategic implementation partner training, through partnership with the training and quality coaching teams, to outline and implement improvements for increased efficiency.
• Provide back-up and peak-load assistance across Enrollment & Billing as needed; complete special projects and perform other duties as assigned.
• Tracks, monitors, updates, and follows-up with strategic implementation partner on audit findings, action plans, and information requests to ensure each item on the action plan is completed in a timely and accurate manner.
• Process plan changes, dependent add-ons, direct transfers, transfer accumulators and more challenging types of enrollments. Update eligibility, enrollment and/or billing of accounts.
• Contact customers or Producer agents for enrollment clarification and/or to provide administrative/regulatory guidelines. This may include creating written correspondence regarding complex billing and enrollment issues.
• 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; may include Web portal usage and contract or regulation interpretation.
• 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. (Preferred)
• Previous customer service experience. (Preferred)
• Health or insurance industry experience. (Preferred)

Requirements

• Expertise in complex enrollment, eligibility, billing, and reconciliation processes
• Experience conducting audits and improving quality and efficiency
• Stronger research, troubleshooting, and problem-solving skills
• Increased knowledge of healthcare regulations and administrative guidelines
• Collaboration experience with customers, partners, and cross-functional teams

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 for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
• Generous paid time off to reenergize.
• Tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• On-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Challenge someone to a game of shuffleboard or ping pong while on campus.