Enrollment Oversight & Quality Specialist

Premera Blue Cross

Mountlake Terrace, WA

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JOB DETAILS

SALARY

$41,500–$62,300 Per Year

SKILLS

Accounting, Administrative Skills, Analysis Skills, Auditing, Billing, Blog, Bookkeeping, Channel Strategies, Coaching, Communication Skills, Continuous Improvement, Corporate Policies, Cross-Functional, Customer Experience, Customer Relations, Customer Satisfaction, Customer Support/Service, Customer/Client Research, Detail Oriented, Environmental Impact, Federal Laws and Regulations, Finance, Fitness, Health Insurance, Health Plan, Healthcare, High School Diploma, Identify Issues, Internet Portal, Interpret Regulations, Keyboards, Maintain Compliance, Nutrition Therapy, Physical Demands, Problem Solving Skills, Process Improvement, Quality Assurance, Quality Metrics, Reconciliation, Regulations, Regulatory Compliance, Service Delivery, State Laws and Regulations, Systems Analysis, Team Player, Technical Research, Technical Support, Time Management, Training/Teaching, Tuition Fees, Work From Home

LOCATION

Mountlake Terrace, WA

POSTED

30+ days ago

**Workforce Classification:** Telecommuter **Join Our Team: Do Meaningful Work and Improve People's Lives** Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we're able to better serve our customers. It's this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. (https://www.premera.com/visitor/careers#awards) Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/ . 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 counts! 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. 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. + Perform other duties as assigned. **What you will bring:** + 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. **What you will gain:** **Regulatory and Compliance Expertise** + You will gain hands-on experience applying contractual, state, and federal guidelines to enrollment scenarios, ensuring all work meets strict regulatory standards. **Technical Troubleshooting and Systems Analysis** + The role involves providing technical support, researching and resolving issues related to processing, system, and software applications-sharpening your analytical and troubleshooting abilities. **Audit and Process Improvement** + You will conduct performance audits, identify compliance gaps, and recommend process improvements, developing a keen eye for detail and continuous improvement. **Customer Service and Communication** + Interacting with internal and external customers via phone, email, and written correspondence will strengthen your customer service and communication skills, especially when explaining complex administrative and regulatory guidelines. **Cross-functional Collaboration and Training** + You will work with cross-functional teams, strategic partners, and participate in training initiatives, enhancing your teamwork, coordination, and training development skills. **Physical Requirements** The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: + This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. + This role requires the ability to use a keyboard and to communicate clearly and understandably in person and over the telephone. **Premera total rewards** Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including: + 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. + Looking for continuing education? We have 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. **Equal employment** **opportunity/affirmative** **action:** Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. **Premera is hiring in the following states, with some limitations based on role or city:** Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin _._ The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally target up to and around the midpoint of the range. **National Salary Range:** $41,500.00 - $62,300.00 **National Plus Salary Range:** $47,400.00 - $71,100.00 _*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska_ _._ We're happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We're committed to creating an environment where all employees are celebrated for their unique skills and contributions. At Premera, we make healthcare work better. By focusing on improving our customers' experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services. Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.

About the Company

Premera Blue Cross

INDUSTRY

Other/Not Classified