Enrollment Oversight – Quality Specialist

October 16, 2026

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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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