Enrollment Oversight & Quality Specialist

Premera Blue Cross

19h•Remote

About The Position

Premera's purpose is to improve customers’ lives by making healthcare work better. The company is committed to being a workplace where employees are empowered to grow, innovate, and lead with purpose, fostering a culture of collaboration and continuous development. The Enrollment Oversight and Quality Specialist role is pivotal in driving accuracy, compliance, and customer satisfaction within enrollment operations. This fast-paced position involves tackling complex enrollment scenarios, collaborating with strategic partners, and championing process improvements. The specialist will perform moderate to complex enrollment, eligibility, billing changes and reconciliation, and account research using various methods, systems, and platforms. The role requires exceptional customer service skills to interact with internal and external customers via phone, email, or written correspondence, explaining administrative and regulatory guidelines and offering alternatives. Additionally, this position supports and coordinates the management and improvement of assigned audit processes, including the development, maintenance, and tracking of related audits, procedures, and efficiency work, particularly in relation to strategic implementation partners.

Requirements

High School diploma or GED (Required).
Minimum of two (2) years of accounting/finance/bookkeeping experience or two (2) years enrollment processing experience (Required).

Nice To Haves

Associate’s degree in accounting.
Previous customer service experience.
Health or insurance industry experience.

Responsibilities

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.
Identifies, recommends and implements process improvements.
Represent 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.
Track, monitor, update, and follow-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.

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, believe it or not, 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, just to name a few.
Generous paid time off to reenergize.
Tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
For our hybrid employees, our 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.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.