This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2195367 Membership Administrator
I
Telecommute within ID, OR, WA or UT
Responsibilities
The Membership Administrator I establishes and maintains eligibility,
bills premium, reconciles cash, pursues aged accounts and provides
eligibility and billing related customer service for Individual, Group,
Government Programs, Cobra and Flexible Spending business.
General Functions and Outcomes
- Process Individual, and/or small, large or specialized group
enrollment applications. Calculate appropriate waiting-period
credit, eligibility data, effective date, and enter benefits, bank
draft identification information, name, social security number,
address, family members and primary care physician information with
network coding, which is consistent with the employer/individual
contract.
- Review, maintain and enter changes on individual and/or group
accounts which may include change of effective date(s) for insured
coverage or members, addition or deletion of insured or members from
coverage, etc.
- Place, receive and track calls to obtain information required to
complete application processing such as calling an employer or agent
to verify date of hire, a subscriber to verify benefit selection, or
the previous carrier to determine effective dates of coverage with
their plan.
- Provide customer service to internal and external customers by
supplying information through written correspondence and responding
to telephone inquiries. Make any necessary corrections or
adjustments.
- Perform all eligibility and reconciliation tasks accurately and
timely for assigned business segment, adhering to established
procedures including identification of discrepancies between payment
and amount invoiced.
- Generate group or individual billings. Review billings and ensure
accuracy before distributing.
- Order member cards and audit these against the member applications
for accuracy, correct corporate logos, lines of business co-pay,
PCP, and any member card comments.
- Appropriately apply corporate underwriting and governmental
guidelines and policies in eligibility processing.
- Ensure cash is processed through daily reconciliation to achieve
established cash turnaround standards.
- Identify and prioritize work in order to meet deadlines.
- Monitor, pursue and report on aged accounts to ensure amounts are
accurate and cleared in time to meet goal of achieving corporate
standards.
- For Government Programs related jobs, gain working knowledge of
State and Federal regulations.
- Incorporate and apply changes made to Membership Accounting,
Underwriting or State and Federal policies and procedures to ensure
current requirements are met.
- Meet established departmental performance expectations.
- Ensure member confidentiality in all aspects of eligibility and
billing processes.
- Comply with MTM, Consortium or Governmental quality, timeliness and
other standards as they relate to membership activities and
responses to inquiries to meet BlueCross and BlueShield Association
or CMS standards and corporate goals.
- Coordinate transfer and receipt of electronic data as applicable
with various outside entities including CMS, employer groups, agents
and vendors.
- Assist with user acceptance and system integration testing.
- Work overtime and on weekends, as necessary.
- Perform various clerical tasks.
- Backup other staff members by providing phone coverage and assisting
with mail, filing and other special projects.
- Attend and participate in training and staff meetings.
Minimum Requirements
- 30 wpm with 95% accuracy typing skills.
- 10-key by touch (8500 keystrokes per our with 95% accuracy
preferred).
- PC experience - Word, Excel and Outlook - or comparable software -
and ability to learn and use complex systems.
- Strong math skills (mathematical calculations and concepts),
judgment and other resources to implement effective problem solving.
- Ability to organize and prioritize work.
- Must be detail-oriented and self-motivated.
- Must be dependable and maintain attendance at or above departmental
standards.
- Must be able to exercise judgment, initiative and discretion in
confidential, mature and sensitive manner.
- Must be able to communicate effectively both orally and in writing.
- Must be able to establish effective working relationships with staff
and customers
Normally to be proficient in the competencies listed above
The Membership Administrator I would have a High School diploma or GED
and one year accounts receivable or customer billing experience or an
equivalent combination of education and job-related work experience.
Depending on candidate\'s experience and geographical location:
The hourly range for this role is \$17.20 - \$26.60.
The bonus target for this position is 5%.