Enrollment Oversight – Quality Specialist

🔥 51 minutes ago

🐻 Alaska, Arizona, +25 more states – Remote

🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $41.5k - $62.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

📋 Description

• Review plan provisions and apply rules for Individual or Group enrollment scenarios • Apply contractual, state, and federal guidelines while ensuring regulatory compliance • Provide technical support by researching and troubleshooting processing, system, and software application issues • Research complex systems issues affecting member eligibility and determine appropriate action • Escalate issues and concerns to ensure desired results • Conduct performance audits for transaction compliance, accuracy, and timeliness • Identify, recommend, and implement process improvements • Represent the department on cross-functional teams and meet with external customers • Review procedures and training materials and implement efficiency improvements • Provide back-up and peak-load assistance across Enrollment & Billing • Complete special projects and other assigned duties • Track, monitor, update, and follow up on strategic implementation partner audit findings, action plans, and information requests • Process plan changes, dependent add-ons, direct transfers, transfer accumulators, and challenging enrollments • Update account eligibility, enrollment, and billing • Contact customers or Producer agents for enrollment clarification and provide administrative/regulatory guidelines • Create written correspondence regarding complex billing and enrollment issues • Meet or exceed department production and quality standards • Educate agents and members on membership, billing, web portal, contract, and regulatory processes

🎯 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) • Associate’s degree in accounting. (Preferred) • Previous customer service experience. (Preferred) • Health or insurance industry experience. (Preferred) • Availability to support business operations during the department's 7:00 AM to 5:00 PM PT coverage window • Participation in a late-shift rotation, typically one day per week, with occasional additional coverage based on business needs • Ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly • Ability to use a keyboard and communicate clearly and understandably in person and over the telephone

🏖️ Benefits

• Medical, vision, and dental coverage with low employee premiums • Voluntary benefit offerings, including pet insurance • Life and disability insurance • Retirement programs, including a 401K employer match and a pension plan vested after 3 years of service • Wellness incentives, including counseling services, stress management programs, and mindfulness programs • Generous paid time off • Tuition assistance for undergraduate and graduate degrees • Employee recognition program • Commuter perks • Free convenient on-site parking • Subsidized on-campus cafes • On-site health and wellness activities • Fitness and well-being center with in-person and virtual workouts and nutritional counseling • Flexible routine and access to on-site resources, networking opportunities, and team engagement for hybrid employees