Membership Eligibility Processor I-III DOE

Company: Cambia Health Solutions, Inc
Location: Burlington
Posted on: May 22, 2023

Job Description:

Membership Eligibility Processor I-III DOERemote in WA, ID, OR, and UTPrimary Job Purpose:The Mbrshp Elig Processor III establishes and maintains accurate subscriber and member level eligibility through processing of new applications, member additions and deletions, policy revisions, demographic changes, renewal changes and any other maintenance affecting eligibility. The Eligibility Processor III applies many of the procedures performed as an Eligibility Processor II, but at a more complex level requiring more in-depth knowledge. The Eligibility Processor III acts more as a mentor to less experienced staff and provides additional assistance to lead and supervisor with tasks and projects as needed.Responsibilities:

• Process individual, small, large, trust 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 contract.
• Review, maintain and enter changes on individual and/or group & trust accounts which may include change of effective date(s) for subscriber coverage or subscriber dependents, addition or deletion of insured or dependents from coverage, etc.
• Place calls to obtain information required to complete application processing such as calling an employer, member 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.
• Handle difficult or escalated situations with members, employer groups, agents, member representatives and internal customers with timely follow through.
• Perform all eligibility tasks accurately and timely to meet MTM requirements.
• Generate group or individual billings.
• Order member cards.
• Identify and prioritize work in order to meet deadlines including state requirements for timeliness and assist others in achieving these goals.
• Incorporate and apply changes made to Membership Accounting, Underwriting and State and Federal policies and procedures to ensure current requirements are met.
• Responsible for meeting established departmental performance expectations.
• Ensure member confidentiality in all aspects of eligibility and billing processes.
• Comply with MTM standards as well as Consortium standards as they relate to group membership activities.
• Handle responses to inquiries to meet BlueCross and BlueShield Association (BCBSA) standards and corporate goals.
• Provide customer service to internal customers and may place and track outgoing calls to external customers including groups, agents and subscribers to obtain information necessary for enrollment.
• Review and apply eligibility rules for trust employees.
• Assist less experienced staff with questions and/or difficult issues or accounts as needed.
• Assist Membership Lead and Supervisor as appropriate.
• Provide support for special projects, tasks, and Membership reports in an accurate and timely manner.
• Provide technical support to the department
• Identify changes needed in processes to improve efficiency in the department
• Establish and maintain excellent rapport with all levels of staff and external customers.
• Perform various clerical tasks.
• Maintain manuals to ensure policies and procedures are current.
• Attend and participate in training and staff meetings.Minimum Requirements:
  • High school diploma or GED
  • 50 wpm keying with 95% accuracy
  • 10-key by touch
  • 18 months experience as an Eligibility Processor II or equivalent with demonstrated ability to meet or exceed accuracy and production standards or an equivalent combination of education and job-related work experience.
  • 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 establish effective working relationships with staff and customers
  • Ability to understand mathematical calculations and concepts
  • Ability to organize and prioritize work
  • PC experience required; experience with Word, Excel, and Outlook or similar software
  • Excellent verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism
  • Ability to listen and communicate appropriately with members, employer groups, agents, member representatives, and coworkers in a manner that promotes positive, professional interaction while maintaining confidentiality.
  • Medical Terminology for WSHIP health questionnaire processors required---Work Environment:
    • Repetitive actions of utilizing a PC keyboard and mouse.
    • Sitting at workstation for extended periods of time.
    • Willing to work overtime and on weekends, as necessary.

Keywords: Cambia Health Solutions, Inc, Bellingham , Membership Eligibility Processor I-III DOE, Other , Burlington, Washington