Membership Representative I

3 weeks ago

Mason, United States Elevance Health Full time

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.

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.

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