Membership Specialist II

Workforce Classification:
Telecommuter

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The Membership Specialist II will perform moderate to complex reconciliation analysis and audit activities for Individual or Group accounts receivable by using reconciliation databases, receipts, electronic file reconciliation and application of basic accounting principles with minimal supervision. Will resolve a variety of enrollment, reconciliation and billing issues of moderate to complex difficulty and participate in coaching internal and external customers concerning contractual guidelines.

Performance drives management of financial risk for the company and customer satisfaction for the members.

Pacific/Mountain/Central Time Zones ONLY working between the hours of 7am to 5pm PT hours

Responsible for identifying, resolving and documenting complex reconciliation discrepancies independently, processing refunds, request transfers of premiums, reinstatements, and insufficient fund issues, processing new enrollment and/or eligibility changes as needed and maintaining accurate and comprehensive notes.

Validate appropriate accounts receivable by conducting detailed reconciliation and audit of group or individual premiums and membership of moderate to complex difficulty.

Utilize various tools/ appropriate system reports, such as in Access or Excel to aid in updating eligibility, enrollment and/or reconciliation of accounts.

Must meet or exceed department metrics: production and quality standards and remain current on company/departmental policies and procedures.

Create written correspondence letters using the appropriate system regarding billing and enrollment issues.

Research, investigate and resolve complex account discrepancies, premium rate, bill flag suspension and/or corrections and billing issues, reproduce and create customized or manual bills as needed or requested by customer, and ensure timely and accurate maintenance and reporting of inventories.

Partner with internal /external partners and members to review and resolve issues; may include Web portal usage and contract interpretation.

Conduct complex electronic file accounts receivable and enrollment reconciliation.

Educate members, brokers, or groups on membership and billing processes, administrative rules to include portal usage and contract or policy interpretation.

Contact clients or state agencies to resolve high volumes of electronic feed and/or web entry issues identified via internal reporting

Analyze enrollment status and apply contract provisions for each enrollment scenario, make changes to records, and research and resolve enrollment system rejections.

Validate Identification Cards are generated in a timely manner.

Respond in a timely manner to all incoming/outgoing member/broker/internal department phone calls.

Ensure compliance with federal and state regulations.

Other duties as assigned

High School diploma or GED. (Required)

Two (2) years of…