Membership Eligibility Processor I-III DOE
Company: Cambia Health Solutions, Inc
Posted on: May 22, 2023
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
- 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
- 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
- Ensure member confidentiality in all aspects of eligibility and
- 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
- 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
- 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
- Attend and participate in training and staff meetings.Minimum
- 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
- 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
- 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
- Medical Terminology for WSHIP health questionnaire processors
- 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
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