Membership Representative I

Title: Membership Representative I

Location:

This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.

The

Membership Representative I

will be responsible for enrollment, billing activities and/or maintaining assigned accounts. Pre-employment test battery may be required.

How you will make an impact:

Responds to incoming calls and may initiate outgoing calls, providing customer service to plan members, providers and employer groups by answering benefit questions, resolving issues and educating callers.

Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections.

Addresses a variety of enrollment questions and/or concerns received by phone or mail.

May be responsible for billing and delinquency processes for assigned groups.

Ensures accuracy and timeliness of the membership and billing function.

Responds to inquiries concerning enrollment processes.

Maintains enrollment database.

May order identification cards.

Determines eligibility and applies contract language for each case assigned.

Performs error output resolution for electronic eligibility and processes error discrepancy list.

Bills, collects premiums and reconciles payments.

Maintains and reconciles premium bill, self-bill and individual billed accounts.

Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.

Screens all forms and data for all paperwork received from Sales and/or Underwriting for new group and/or group re-classing benefits.

Makes request to Underwriting, Sales or Brokers for missing information and/or forms needed for new group or re-class of existing group.

May be responsible for loading rates to new groups and renewal/re-class groups within the appropriate system.

Screens group for benefits to determine if existing or new, recognizing when benefits are not standard and handling as appropriate.

Thoroughly documents inquiry outcomes for accurate tracking and analysis.

Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Performs basic job functions with help from co-workers, specialists and managers on non-basic issues.

Minimum Requirements

HS diploma or GED and related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Qualifications

Knowledge pf ISG mainframe, PEGA, and IE3 highly preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.