Enrollment Oversight & Quality Specialist

Premera Blue Cross•WA Other Telecommuter, WA

1d•$41,500 - $71,100•Remote

About The Position

The Enrollment Oversight & Quality Specialist performs moderate to complex enrollment, eligibility, billing-change, reconciliation, and account-research work using a variety of methods, systems, and platforms. The role provides timely, professional service to internal and external customers by phone, email, and written correspondence; explains administrative and regulatory guidelines and their effects; and helps customers identify alternatives. The specialist also supports and coordinates the management and improvement of assigned audit processes, including developing, maintaining, and tracking audits, procedures, and efficiency work with team members and strategic implementation partners. Candidates must be available to support operations during the department’s 7:00 AM–5:00 PM PT coverage window and participate 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–5:00 PM PT. This is primarily a sedentary role requiring occasional exertion of up to 10 pounds and frequent or constant negligible exertion to move objects. The role requires keyboard use and clear communication in person and over the telephone. The position is classified as telecommuter.

Requirements

High school diploma or GED.
At least two years of accounting, finance, or bookkeeping experience, or at least two years of enrollment-processing experience.
Exceptional customer-service skills and the ability to communicate professionally with internal and external customers by phone, email, and written correspondence.
Ability to explain administrative and regulatory guidelines and their impact to members and agents.
Ability to support business operations during the 7:00 AM–5:00 PM PT coverage window and participate in a late-shift rotation, typically one day per week, with occasional additional coverage.
Ability to use a keyboard and communicate clearly and understandably in person and over the telephone.
Ability to perform the stated sedentary physical requirements, with or without accommodation.

Nice To Haves

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

Responsibilities

Review plan provisions and apply rules for Individual or Group enrollment scenarios while following contractual, state, and federal guidelines.
Provide technical support to assigned teams and strategic implementation partners by researching and troubleshooting processing, system, and software-application issues.
Research complex systems issues affecting member eligibility, determine appropriate actions, and escalate issues or concerns when needed.
Conduct performance audits to assess transaction compliance, accuracy, and timeliness; identify, recommend, and implement process improvements.
Represent the department on cross-functional teams and meet with external customers as required.
Review and improve procedures and training materials in partnership with training and quality coaching teams.
Provide backup and peak-load assistance across Enrollment & Billing, complete special projects, and perform other assigned duties.
Track, monitor, update, and follow up with strategic implementation partners on audit findings, action plans, and information requests to support timely and accurate completion.
Process plan changes, dependent add-ons, direct transfers, transfer accumulators, and other challenging enrollments; update account eligibility, enrollment, and billing.
Contact customers or Producer agents to clarify enrollment information or explain administrative and regulatory guidelines, including through written correspondence about complex billing and enrollment issues.
Meet or exceed department production and quality standards and remain current on company and departmental policies and procedures.
Educate agents and members on membership and billing processes and administrative rules, including web-portal use and contract or regulation interpretation.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance.
Life and disability insurance.
Retirement programs, including a 401(k) employer match and a pension plan vested after three years of service.
Wellness incentives and mental well-being resources, including counseling, stress-management, and mindfulness programs.
Generous paid time off.
Tuition assistance for undergraduate and graduate degrees.
Employee recognition program.
Commuter perks.
Free on-site parking.
Subsidized on-campus cafes.
On-site activities, including health and wellness events.
Fitness and well-being center with in-person and virtual workouts and nutritional counseling.