Enrollment Oversight & Quality Specialist

About the role

The Enrollment Oversight and Quality Specialist position plays a pivotal role in driving accuracy, compliance, and customer satisfaction in enrollment and quality assurance at Premera. This role requires a combination of technical skills, strong customer service, and the ability to conduct performance audits and recommend process improvements.

Responsibilities

• Review plan provisions and apply specific rules to individual or group enrollment scenarios.
• Ensure compliance with contractual, state, and federal guidelines.
• Provide technical support to assigned teams and strategic implementation partners.
• Research and resolve issues related to processing, system, and software applications.
• Conduct performance audits to ensure transaction compliance, accuracy, and timeliness.
• Identify and recommend process improvements.
• Represent department on cross-functional teams and meet with external customers as required.
• Develop, maintain, and track related audits, procedures, and efficiency work.
• Support and coordinate the management and improvement of assigned audit processes.
• Escalate issues or concerns to ensure desired results.
• Update eligibility, enrollment, and/or billing of accounts.
• Contact customers or producer agents for enrollment clarification and/or provide administrative/regulatory guidelines.

Requirements

• High School diploma or GED.
• Minimum of two (2) years of accounting/finance/bookkeeping experience or two (2) years enrollment processing experience.
• Associate’s degree in accounting.
• Previous customer service experience.
• Health or insurance industry experience.

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.

Skills

• Regulatory and Compliance Expertise.
• Technical Troubleshooting and Systems Analysis.
• Audit and Process Improvement.
• Customer Service and Communication.
• Cross-functional Collaboration and Training.

Benefits

Premera offers a comprehensive total rewards package designed to support, resources, and opportunities for employees to thrive and grow. This includes medical, vision, and dental coverage, life and disability insurance, retirement programs, wellness incentives, and more.

Pay

The salary range for this role is $41,500.00 - $62,300.00 National and $47,400.00 - $71,100.00 National Plus salary range, depending on various factors including geographic location, market conditions, and specific skills and experience.

Schedule

This role is available as a telecommuter position, offering flexibility and the option to work remotely.