Reimbursement Plan Admin I​/II

Job Description: The Reimbursement Plan Administrator responds to and resolves written, telephone, and personal inquiries from subscribers, groups, and providers concerning all departmental products, policies, and procedures in a professional and efficient manner. This position coordinates and monitors daily administrative activities regarding departmental products to ensure established standards and deadlines are met.

• Responds to all inquiries from an internal and external perspective completely, accurately, and timely and in a professional and efficient manner. Supports customer service team in researching member inquiries.
• Researches claims and determines claim eligibility in accordance with IRS regulations. Researches and resolves adjustment transactions.
• Performs online processing and adjudication of claims according to contract specifications/provisions and the company’s guidelines and policies as they pertain to the account.
• Maintains membership data including enrolling, terminating, and updating participant and group data. Administers group and member accounts in accordance with all appropriate regulations and process all activity within service time standards.
• Participates and attends ongoing training to further knowledge of regulations, software systems, policies and procedures, and develops skills to accurately fulfill requirements of the job.
• Maintains knowledge of rules, regulations, policies, and benefits governing the department product portfolio. Performs departmental and team functions according to established desk level procedures (DLP). Participates in the development, updating and monitoring of DLP.
• Openly participates and collaborates with departmental and team members to execute on assigned tasks.
• Consistently meets the established departmental and team productivity metrics.
• Assists in system and release testing and troubleshooting.
• 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.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

• Performs advanced research and resolution of inquiries and adjustments on behalf of participants, clients, brokers or providers.
• Assists in resolution of escalated or systematic issues. Proactively identifies error trends.
• Assists in client audits and data comparisons.
• Services strategic accounts as well more complex accounts within the Departmental product portfolio.
• All duties performed under limited supervision.

• High School diploma or equivalent. Associate degree in business administration or related field preferred.
• Two or more years related experience.
• Strong problem solving, reasoning, and organizational skills.
• PC experience including knowledge of Microsoft Word and Excel.
• Excellent oral and written communication skills. Ability to communicate effectively while working collaboratively and maintaining positive relationships with peers and clients.
• Ability to manage multiple projects.

• Four or more years of benefit processing experience.
• Strong proficiency in the use of Microsoft Word and Excel.
• Advanced knowledge of Microsoft Word and Excel.
• Experience with one or more of the product portfolio’s Administration software applications.
• Expertise in all aspects of rules and regulations for core operations.

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Level…