Enrollment Oversight – Quality Specialist

Job 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
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