Enrollment Oversight & Quality Specialist

Enrollment Oversight And Quality Specialist

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.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America's Best Midsize Employers for the fourth time.

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 operationswhere every detail matters and your contributions truly count!

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 :

What you will gain :

Regulatory and Compliance Expertise

Technical Troubleshooting and Systems Analysis

Audit and Process Improvement

Customer Service and Communication

Cross-functional Collaboration and Training

Physical Requirements

Premera total rewards

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.

Equal employment opportunity

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,