Group Accounts Representative

Group Accounts Representative (Administrative)

We're hiring a Group Accounts Representative to manage group setup, eligibility, billing, and  distribution. This client-facing role ensures accurate account data and smooth onboarding through electronic file troubleshooting. You'll also monitor account balances, resolve payment issues, and support financial accuracy. If you're detail-oriented and experienced in health benefits operations, we'd love to hear from you to join a collaborative team in a hybrid work environment.

Position Summary:

The Group Accounts Representative is responsible for the accurate setup, maintenance, and ongoing administration of group accounts within the system, including eligibility, rating, billing configuration, and web access. This role ensures a seamless onboarding experience by troubleshooting and resolving issues related to initial electronic data files and system setup.

This position plays a critical role in maintaining financial accuracy by monitoring and reconciling client account balances, ensuring billing integrity, and supporting consistent revenue cycle performance. As a client-facing representative, this role serves as a key point of contact for resolving eligibility, billing, and payment-related inquiries, delivering timely, professional, and solution-oriented service.

Essential Functions and

Job Responsibilities:

1. Establishes and maintains groups information including the setup for eligibility, rates, billing standards and web access. This work may include but is not limited to:

• Loading and maintaining accurate eligibility and premium rates into the administration system.
• Ensuring accuracy for rate setup and billing standards.
• Determining the appropriate system changes needed to script for policies.
• Testing group setup and ensuring the accuracy of systems based on policy requirements.
• Setting up COB, dual Delta and member merge eligibility for appropriate claims payments.
• Validating, assigning, and managing client user web access for processing eligibility, billing and retrieving premium billing invoices.
• Notifying EDI team to load initial eligibility and validate for the  process.
• Terminating eligibility and billing processes including reconciliation for final billing.

2. Troubleshoots issues with electronic eligibility files. This work may include but is not limited to:

• Collaborating with the EDI team to address issues with electronic eligibility files.
• Reviewing error reports and contacting clients for missing information to complete enrollment processing.
• Identifying file issues and recommending solutions to clients.

3. Supplies groups with timely and accurate . This work includes but is not limited to:

• Monitoring the production and distribution process for  on all accounts.
• Researching questions or issues related to .
• Ensuring accurate and on-time delivery of all  within a group.
• Coordinating with the Group Accounts Supervisor on custom .

4. Communicates with clients regarding account balances, , eligibility questions and other file issues. This work may include but is not limited to:

• Providing professional and consistent updates on the receipt of electronic eligibility files and the setup of account eligibility and .
• Contacting clients to provide responses to questions and solutions to issues related to eligibility, web access or billing.
• Collaborating with Account Managers to ensure strong communication for shared accounts.
• Responding to calls and emails within a timely manner to ensure a positive client experience.

5. Monitors and reconciles account balances to ensure accuracy and payment on accounts. This work may include but is not limited to:

• Monitoring receivable balances to ensure timely payments and research disputed or unreconciled account balances.
• Addressing account balance issues with clients to ensure resolution.
• Drafting delinquency letters and monitoring collection proceeding on balances.
• Suspending accounts or initiating cancellation requests due to non-payment, in accordance with company guidelines, to ensure claim payments are placed on hold until the account is resolved.
• Validating that self-billed client payments fall within the established exception thresholds, processing necessary adjustments and true-up billing to ensure account accuracy.
• Reporting payment discrepancies to the Finance department for corrections.

Qualifications:

• High School diploma or equivalent required.
• Minimum of 3 years' experience in the health benefits arena, preferably in operations, receivables, or reconciliation processes.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Advanced problem-solving and decision-making abilities.
• Exceptional verbal and written communication skills.
• Ability to collaborate effectively with customers, colleagues, and leadership at all levels.
• Critical Thinking
• Organizational skills
• Quality focused

This position functions as a hybrid role working from both home and in-office environments. Any home office setting must be conducive to all guidelines outlined by the organization.…