Enrollment Reconciliation Specialist

Position title: Enrollment Reconciliation Specialist

Reports to: Enrollment Reconciliation Supervisor 

FLSA status: Non-Exempt

Position Summary The Enrollment Reconciliation Specialist will provide support on a wide range of complex customer support services to include responsibility for customer support escalations, complex case management, and reconciliation of enrollment records. The Reconciliation team will include experienced individuals who primarily provide support for escalated or technically complex situations.

Responsibilities (Position may include additional functions not listed)

•  Provide thorough, timely, and accurate resolution of carrier reconciliation disputes and escalated complex cases via telephone, email, and other methods in partnership with a high-volume call center to include peak workloads during annual open enrollment periods.
• Accurately research and resolve data discrepancies to ensure data integrity across external partners.
• Analyze data, identify trends, troubleshoot technical issues, and research root cause of data inconsistencies.
• Complete resolution of complex cases to include rebuilding enrollment cases and working with a technology vendor to override standard system behavior where needed.
• Support wide range of consumer, carrier, consumer connector and other stakeholder questions such as general insurance enrollment, financial assistance eligibility, making enrollment changes, use of the online technology, individual enrollment, plan selection alternatives, family status changes, and other insurance and/or ACA related topics.
• Respond professionally and appropriately to inbound calls, difficult or emotional customer situations and other sources of customer inquiries.
• Utilize YHI’s technology platform to review relevant consumer information and resolve consumer concerns or questions and complete accurate data entry of contact with consumers
• Conduct research as necessary to effectively resolve complex consumer situations.
• Adhere to YHI policies, procedures, and expectations to meet YHI performance objectives in service, quality assurance, attendance and productivity.
• Support YHI’s carrier appeals process, carrier reconciliations, and renewal of eligibility for non-financial assistance. Support YHI’s processing of non-financial eligibility renewals and appeals.
• May create, route, and respond to consumer and/or agent/broker tickets.
• Support YHI’s consumer support system, which may include case management, escalations, appeals and grievances.
• Perform other duties as assigned.

Qualifications (Required knowledge, skills, abilities, education, experience, etc.)

• Associates degree preferred or equivalent through professional experience
• 1-year customer service experience, including resolving complex customer issues
• Ability to troubleshoot both technical and non-technical issues
• Excellent verbal and written communication skills, including strong interpersonal telephone skills
• Ability to effectively listen and elicit information
• Strong computer skills, including Microsoft Office and ability to learn/utilize other technology applications
• Ability to navigate multiple computer systems, applications, and utilize search tools to find information
• Strong problem solving, reading comprehension, and troubleshooting skills
• Ability to sit and/or stand at a desk and work with a computer for extended periods of time
• Knowledge of the Affordable Care Act (ACA) preferred
• Ability to work in a fast-paced workplace, adapt to a continually evolving environment
• A committed team player with exceptional interpersonal, problem-solving, and communication skills with ability to develop and maintain cooperative and productive work relationships

Ability to assume responsibility and maintain confidentiality consistent with the values and integrity of YHI

Physical & Other Requirements

• Ability to work in an office environment, primarily sedentary.
• Consistent attendance is required, including full-time during initial three-week training session (8 hours/day, 5 days/week) as well as regularly scheduled shifts thereafter.
• Ability to listen to and understand others as well as ability to give and receive instructions via telephone, computer messages, face-to-face, and in writing
• Ability to operate computer and software applications; use of normal office machines
• Availability to work additional hours or weekends based on call center demands
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*The functions described herein are not the only responsibilities and tasks to be performed by the individual occupying this position. The individual will be required to follow any other instructions and to perform any other job-related duties as required by his/her supervisor or manager. Requirements stated herein are minimum levels of knowledge, skills, and/or abilities to qualify for this position. To perform the responsibilities of this position successfully, the individual will possess the abilities and aptitudes to perform each task proficiently. “Ability” means to possess and apply both knowledge and skill.

This job description includes the essential functions of the job that an incumbent must be able to perform with or without reasonable accommodation.

This document does not create an employment contract, implied or otherwise. The organization maintains “at will” employment. This job description is subject to review and may be revised or updated at management’s discretion.