Enrollment Resolution Examiner I

Job description

Job Description:

Summary:

The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas.

Essential Primary Responsibilities/Accountabilities:

Level I

• Responsible for reconciliation of regulatory and Health Plan Enrollment data through audit and review, utilizing the internal and external guidelines/regulations/policies and procedures. Strong knowledge of reporting and associated regulatory guidelines used to verify enrollment and billing accuracy to ensure plan is paid correctly in order to maintain accurate financial records.
• Responsible for ensuring member and/or group documentation and transactional updates are completed to reconcile account discrepancies. Receives, reviews and updates discrepancies from internal departments and external customers relating to the Membership subscriber/member/group files
• Investigates, works, analyzes, tracks and monitors operational issues identified during the financial balancing adjustment of funds. Participates in process and technology improvement efforts to identify and remove barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction.
• Prepares regular and periodic reports for the review and assurance of following processing guidance including but not limited to, the operations reporting of all transactions.
• Initiates necessary requests to other operational areas to resolve identified problems or recommendations for process improvement. Communicates with internal and external customers and also, provides supporting documentation and makes recommendations for procedure changes based on analysis completed.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Be proficient in one line of business and able to process inventory from other lines of business as requested.

Level II

in addition to Level I responsibilities, Level II will perform the following:

• Mentors and collaborates with others on the team in utilizing tools, sharing best practices, and serving as a role model within a team unit structure. Ability to support other team members within your primary line of business by responding to questions, demonstrating key tasks and reviewing work
• Subject matter expert in one line of business and proficient in a several inventory areas in other lines of business.
• In depth understanding and working knowledge of the cross functional enrollment processes as they pertain to the Resolution Examiner work to research and resolve discrepancies or inquiries.
• Ability to support implementation of new processes and procedures related to Resolution Examiner inventory work. Accountability included but not limited to, creation of test cases, testing of the process, end user testing, creating documents and establishing procedures. Represents Enrollment Resolution on corporate projects as well as cross functional work groups, acting as a subject matter expert, providing advice and counsel to project teams and leadership on requirements

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

• Conducting financial analyses and recommendations, or related work experience and proven ability to exercise the requirements and responsibilities of the position required.
• Three (3) years’ experience with financial data or Health Insurance Enrollment experience; or an associate degree in finance, accounting, or similar discipline.
• Capable of establishing constructive relationships with all levels of internal and external of the organization.
• Must be able to prioritize assignments and work accurately and independently within established time frames.
• Must be flexible and able to adjust to rapidly changing priorities.
• Must have solid communication skills – both verbal and written.
• Proven organizational, analytical, and time management skills.
• Computer proficiency, including experience in Microsoft Office Suite.
• Strong attention to detail and accuracy.

Level II

• A minimum of five (5) years health insurance operations experience preferred.
• Ability to represent the department independently as a subject matter expert in discussions with other areas of the company.
• In depth regulatory and Enrollment process knowledge in one line of business and working knowledge in an additional line of business.
• Proven ability to support and train peers.

Physical Requirements:

• Ability to complete work in a traditional office environment under fluorescent lighting.
• Ability to arrive on time at work and as scheduled.
• Ability to meet minimum performance metrics.
• Ability to orally communicate.
• Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time.
• Must be able to travel across the enterprise.
• Ability to work in a home office for continuous periods of time for business continuity.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade N5: Minimum: $21.20 - Maximum: $33.03

Level II: Grade N6: Minimum: $22.50 - Maximum: $35.00

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. 

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.