Enrollment & Billing Specialist III

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities.

Residency in or relocation to Louisiana is preferred for all positions.

The Enrollment and Billing Specialist III is able to perform the duties of both the E&B Specialist I and II. Research, resolve and respond to complex issues and concerns on behalf of both internal and external customers. Maintain accurate and up-to-date membership records to ensure correct premium billing and claim processing within contract limits. Calculate and process refunds in FACETS and coordinate with the Accounting Dept for disbursement.

Research and respond to internal high-priority cases or urgent inquiries. Work cohesively in a team and shift work tasks and priorities as needed.

This role does not manage people This role reports to this job: SUPERVISOR, ENROLLMENT & BILLING.

In order to effectively fulfill this position, the incumbent must be in contact with:
Accounting, Actuarial, BET, Claims, Compliance, Customer Service, Finance, Legal, Sales and Marketing, Underwriting, IT, District Offices, Producers, Group Leaders, Brokers, 834 vendors and all levels of Enrollment and Billing personnel and other BCBSLA departments as needed.

Education High School Diploma or equivalent is required Associate's is preferred.

Work Experience 4 years of clerical experience is required 2 years of Enrollment and Billing experience across different E&B units is required Required experience can run concurrently Customer Service or Marketing experience is preferred.

Skills and Abilities

Must have thoroughly understand insurance and working knowledge of enrollment and billing functions and FACETS system. Must be able to identify compliance issues and complex business needs, develop solutions and resolve problems. Must be able to coordinate with other internal departments as part of Triage Team to ensure that all required customer information is gathered comprehensively for all internal parties involved as early in the process as possible.

Consolidate and communicate data requests back to the Group Leader. Must have working knowledge of relevant software (e.g., MS Word, Excel, Outlook, etc.) and related software as well as other corporate programs and applications and the ability to learn new systems. Must have thorough knowledge to apply company policies and procedures, company guidelines, state and federal laws and mandates (e.g., HIPPA, COBRA, PPACA, etc.)

to ensure information is current and accurate. Must demonstrate verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism. Must be able to prioritize multiple responsibilities, make decisions, find solutions and work independently in order to meet aggressive deadlines, and adapt to a fast-paced, changing environment. Able to cohesively work in a team environment to ensure efficient and effective completion of all tasks for assigned groups.

Must have strong organizational and analytical abilities and effective interpersonal skills. Must be able to recognize inconsistencies and gaps in business processes and take appropriate actions. Must possess a positive attitude which embraces customer-centric behavior, organizational cultural beliefs, company values as well as divisional requirements including efficiency, accuracy, productivity, and/or work schedule and confidentiality of information. Must be flexible to shift priorities as needed to cover multiple tasks in the process as directed by the Supervisor.

Must have working knowledge about plan products, company initiatives and other operational changes affecting the department. Must be punctual and have regular attendance. Must be able to work overtime during peak enrollment and renewal season.

Licenses and Certifications None Required.

Duties of an Enrollment and Billing Specialist I and II Serve as the subject matter expert with thorough knowledge of enrollment and billing processes including company policies and procedures, compliance guidelines, and state and federal laws and mandates (e.g., HIPPA, COBRA, PPACA, etc.). Work with Legal, DOI, and Compliance Specialists to ensure issues/cases that come form DOI are submitted in a timely manner.

Coordinate with Underwriting, Marketing, and Enrollment as…