Enrollment Resolution Examiner

Job Description: The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas.

The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas.

• Responsible for reconciliation of regulatory and Health Plan Enrollment data through audit and review, utilizing the internal and external guidelines/regulations/policies and procedures. Strong knowledge of reporting and associated regulatory guidelines used to verify enrollment and billing accuracy to ensure plan is paid correctly in order to maintain accurate financial records.
• Responsible for ensuring member and/or group documentation and transactional updates are completed to reconcile account discrepancies. Receives, reviews and updates discrepancies from internal departments and external customers relating to the Membership subscriber/member/group files
• Investigates, works, analyzes, tracks and monitors operational issues identified during the financial balancing adjustment of funds. Participates in process and technology improvement efforts to identify and remove barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction.
• Prepares regular and periodic reports for the review and assurance of following processing guidance including but not limited to, the operations reporting of all transactions.
• Initiates necessary requests to other operational areas to resolve identified problems or recommendations for process improvement. Communicates with internal and external customers and also, provides supporting documentation and makes recommendations for procedure changes based on analysis completed.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Be proficient in one line of business and able to process inventory from other lines of business as requested.

• Mentors and collaborates with others on the team in utilizing tools, sharing best practices, and serving as a role model within a team unit structure. Ability to support other team members within your primary line of business by responding to questions, demonstrating key tasks and reviewing work
• Subject matter expert in one line of business and proficient in a several inventory areas in other lines of business.
• In depth understanding and working knowledge of the cross functional enrollment processes as they pertain to the Resolution Examiner work to research and resolve discrepancies or inquiries.
• Ability to support implementation of new processes and procedures related to Resolution Examiner inventory work. Accountability included but not limited to, creation of test cases, testing of the process, end user testing, creating documents and establishing…