Membership Representative

Job Description

Responsible for administering member and group enrollment, eligibility, and membership activities to ensure accurate and compliant membership records across health plan products. Performs enrollment transactions, resolves eligibility and billing issues, researches and corrects discrepancies, and provides support to members, agents, and benefits administrators. Maintains data integrity across multiple systems while ensuring adherence to regulatory requirements, operational procedures, and service standards. Facilitates timely resolution of enrollment, billing, and membership inquiries to support an accurate and positive member experience.

• Enroll and renew groups and members, and maintain accurate membership records, including additions, deletions, and changes. and terminations for the health plans.
• Perform standard and moderately complex group level/or member-level enrollment for medical and ancillary products in accordance with established procedures.
• Maintain accurate, timely membership and eligibility records across multiple systems, ensuring data integrity and compliance.
• Address eligibility issues by applying applicable federal and state regulations and internal and external governance requirements.
• Process billing inquiries and reconciliation activities, including researching billing discrepancies and initiating corrections or reverse transactions as needed.
• Research and respond to enrollment errors via telephone or written communication, clearly documenting issues, corrective actions taken, and applicable policies or procedures.
• Receive and place calls to respond to questions, obtain information, and resolve inquiries related to membership, enrollment, group and individual records, and contracts.
• Support agents, benefits administrators, and members with general billing and enrollment questions.
• Process back-end error reports for electronic enrollment reports, ensuring timely identification, resolution, and documentation of discrepancies.

• High school diploma or GED
• 0-2 years of experience in related field

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused. In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

* Based on annual corporate goal achievement and individual performance.

$41,600.00 - $66,561.00

• Accounts Payable Process
• Answering Telephones
• Benefits Administration
• Billing
• Billing Process
• Billing Reconciliation
• Customer Care
• Customer Service
• Data Entry
• Email Management
• Enrollm…