[Hiring] Membership Specialist II @Premera Blue Cross

Role Description

The Membership Specialist II will perform moderate to complex reconciliation analysis and audit activities for Individual or Group accounts receivable by using reconciliation databases, receipts, electronic file reconciliation and application of basic accounting principles with minimal supervision. Will resolve a variety of enrollment, reconciliation and billing issues of moderate to complex difficulty and participate in coaching internal and external customers concerning contractual guidelines. Performance drives management of financial risk for the company and customer satisfaction for the members.

Pacific/Mountain/Central Time Zones ONLY working between the hours of 7am to 5pm PT hours.

What you will do:

• Responsible for identifying, resolving and documenting complex reconciliation discrepancies independently, processing refunds, request transfers of premiums, reinstatements, and insufficient fund issues, processing new enrollment and/or eligibility changes as needed and maintaining accurate and comprehensive notes.
• Validate appropriate accounts receivable by conducting detailed reconciliation and audit of group or individual premiums and membership of moderate to complex difficulty.
• Utilize various tools/appropriate system reports, such as in Access or Excel to aid in updating eligibility, enrollment and/or reconciliation of accounts.
• Must meet or exceed department metrics: production and quality standards and remain current on company/departmental policies and procedures.
• Create written correspondence letters using the appropriate system regarding billing and enrollment issues.
• Research, investigate and resolve complex account discrepancies, premium rate, bill flag suspension and/or corrections and billing issues, reproduce and create customized or manual bills as needed or requested by customer, and ensure timely and accurate maintenance and reporting of inventories.
• Partner with internal/external partners and members to review and resolve issues; may include Web portal usage and contract interpretation.
• Conduct complex electronic file accounts receivable and enrollment reconciliation.
• Educate members, brokers, or groups on membership and billing processes, administrative rules to include portal usage and contract or policy interpretation.
• Contact clients or state agencies to resolve high volumes of electronic feed and/or web entry issues identified via internal reporting.
• Analyze enrollment status and apply contract provisions for each enrollment scenario, make changes to records, and research and resolve enrollment system rejections.
• Validate Identification Cards are generated in a timely manner.
• Respond in a timely manner to all incoming/outgoing member/broker/internal department phone calls.
• Ensure compliance with federal and state regulations.
• Other duties as assigned.

Qualifications

• High School diploma or GED. (Required)
• Two (2) years of recent accounting/finance/bookkeeping experience or an Associate’s Degree in accounting/finance/bookkeeping. (Required)
• One (1) year prior experience as Membership Analyst I or in a Premera position with reconciliation experience. (Required)
• Health or insurance industry experience. (Preferred)
• Associates or Bachelor’s degree in accounting/finance. (Preferred)

Requirements

• Build expertise in complex billing, enrollment, and account reconciliation.
• Strengthen analytical and problem-solving skills through detailed audits.
• Gain experience using Excel, Access, and reconciliation tools.
• Develop customer communication and issue-resolution skills.
• Expand knowledge of healthcare regulations, contracts, and membership processes.

Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
• Generous paid time off to reenergize.
• Tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• On-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs, and more.
• Complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Challenge someone to a game of shuffleboard or ping pong while on campus.