Enrollment Oversight – Quality Specialist

This is a fully remote position, open to applicants in Alaska, +26 more states.

📋 Description

• Evaluate plan provisions and implement rules for Individual or Group enrollment scenarios.

• Adhere to contractual, state, and federal regulations while ensuring compliance with all relevant guidelines.

• Offer technical support by investigating and resolving processing, system, and software application issues.

• Analyze complex systems issues that impact member eligibility and determine the necessary actions.

• Elevate issues and concerns to guarantee optimal outcomes.

• Conduct performance audits to ensure compliance, accuracy, and timely transactions.

• Identify, propose, and execute process enhancements.

• Represent the department in cross-functional teams and engage with external customers.

• Review procedures and training materials, implementing efficiency improvements where applicable.

• Provide backup support and assistance during peak loads across Enrollment & Billing.

• Complete special projects and fulfill other assigned responsibilities.

• Track, monitor, update, and follow up on audit findings, action plans, and information requests from strategic implementation partners.

• Process plan modifications, dependent additions, direct transfers, transfer accumulators, and challenging enrollments.

• Update account eligibility, enrollment, and billing information.

• Communicate with customers or Producer agents for enrollment clarification while providing administrative and regulatory guidelines.

• Draft written correspondence concerning complex billing and enrollment matters.

• Meet or surpass departmental production and quality benchmarks.

• Educate agents and members about membership, billing, the web portal, contract details, and regulatory processes.

⛳️ Requirements

• High School diploma or GED. (Required)

• A minimum of two (2) years of experience in accounting, finance, or bookkeeping, or two (2) years of enrollment processing experience. (Required)

• Associate’s degree in accounting. (Preferred)

• Previous experience in customer service. (Preferred)

• Background in the health or insurance industry. (Preferred)

• Availability to support business operations during the department's coverage window from 7:00 AM to 5:00 PM PT.

• Willingness to participate in a late-shift rotation, typically one day per week, with occasional additional coverage as needed by the business.

• Capability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly.

• Proficient in using a keyboard and communicating clearly and understandably both in person and over the telephone.

🏝️ Benefits

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit options, including pet insurance.

• Life and disability insurance coverage.

• Retirement programs featuring a 401K employer match and a pension plan that vests after 3 years of service.

• Wellness incentives such as counseling services, stress management programs, and mindfulness initiatives.

• Generous paid time off policy.

• Tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program.

• Commuter benefits.

• Free, convenient on-site parking.

• Subsidized on-campus cafes.

• On-site health and wellness activities.

• A fitness and well-being center offering in-person and virtual workouts, along with nutritional counseling.

• Flexible work routines with access to on-site resources, networking opportunities, and team engagement for hybrid employees.