Enrollment Oversight – Quality Specialist

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $41.5k - $62.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

⚕️ 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

• 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.

🎯 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. • Previous customer service experience. • Health or insurance industry experience.

🏖️ 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. • 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.