Enrollment Oversight – Quality Specialist

Premera Blue Cross

Enrollment Oversight and Quality Specialist ensuring compliance and customer satisfaction in healthcare enrollment processes. Collaborating with teams to improve accuracy and drive process enhancements.

Posted 7/14/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $41,500 - $62,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in enrollment processing, compliance with federal and state regulations, and effective customer service within the health or insurance industry. Capable of conducting performance audits, implementing process improvements, and providing technical support to enhance operational efficiency.

Highest-signal resume keywords

Enrollment Processing ExperienceCompliance With Federal And State RegulationsPerformance AuditingCustomer Service ExperienceProcess Improvement Implementation

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

AccountingFinanceBookkeepingPlan Provision ReviewEligibility UpdateBilling ManagementContractual Guidelines ApplicationSystem TroubleshootingData TrackingAudit Monitoring

Soft Skills

Research SkillsCommunication SkillsProblem-SolvingCollaborationCustomer Support

Certifications & Qualifications

High School DiplomaGEDAssociate's Degree In Accounting

Industry Keywords

Health IndustryInsurance IndustryEnrollment ScenariosRegulatory GuidelinesMember EligibilityCross-Functional TeamsTraining Material ReviewAdministrative RulesWeb Portal UsageComplex Systems Issues

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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.