[Hiring] Enrollment Resolution Examiner @Excellus BCBS

Role Description

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.

• Level I:
  • Responsible for reconciliation of regulatory and Health Plan Enrollment data through audit and review, utilizing internal and external guidelines/regulations/policies and procedures.
  • Strong knowledge of reporting and associated regulatory guidelines used to verify enrollment and billing accuracy.
  • Responsible for ensuring member and/or group documentation and transactional updates are completed to reconcile account discrepancies.
  • 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.
  • Initiates necessary requests to other operational areas to resolve identified problems or recommendations for process improvement.
  • Communicates with internal and external customers and provides supporting documentation and recommendations for procedure changes based on analysis completed.
  • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values.
  • Maintains high regard for member privacy in accordance with 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.
  • Subject matter expert in one line of business and proficient in 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.
  • Ability to support implementation of new processes and procedures related to Resolution Examiner inventory work.
  • Accountability includes creation of test cases, testing of the process, end-user testing, creating documents, and establishing procedures.
  • Represents Enrollment Resolution on corporate projects and cross-functional work groups, acting as a subject matter expert.

Qualifications

• Conducting financial analyses and recommendations, or related work experience.
• 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.

Requirements

• A minimum of five (5) years health insurance operations experience preferred for Level II.
• 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.

Benefits

• Compensation Range(s):
  • Level I: Grade N5: Minimum: $21.20 - Maximum: $33.03
  • Level II: Grade N6: Minimum: $22.50 - Maximum: $35.00
• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.

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.