Group Setup Specialist III

Job Summary
Prepares the system for new member enrollment with minimal guidance by entering and translating contractual information into data attributes in the membership system, identifying gaps or inconsistencies in group purchase and renewal submissions, developing standard structures in the system to capture membership criteria, and reviewing purchase details for accuracy and completeness of contract provisions. Performs system testing for new products, system changes, and other updates. Promotes member satisfaction by analyzing standard member issues to drive improvement processes. Provides quality customer service through communication with groups and members. Collaborates with senior team members and partner teams to translate purchase information into data attributes and address issues in group setup processes with minimal guidance. Maintains compliance with relevant laws and regulatory agencies throughout daily work with supervision, following established guidelines, procedures, and policies. Compiles data to advise stakeholders of system performance issues and patterns and tracks status of groups in setup pipeline.

Essential Responsibilities

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Supports coordination across teams by: collaborating with partner teams (e.g., sales, account management, case installation, benefits, underwriting, membership administration) to effectively translate purchase information into data attributes and prepare the system for new member enrollment with minimal guidance; and working with team members and relevant partners to address standard issues as they arise to ensure efficient Group Setup processes.
• Compiles and applies departmental data by: compiling data as requested to advise stakeholders (e.g., sales, case installation) of system performance issues and patterns where submissions are nonconforming or inaccurate; and tracking status of groups in setup pipeline and updating stakeholders as needed;
• Pursues member satisfaction by: analyzing standard member feedback/issues and driving small-scope improvement processes to enhance Group Setup processes;communicating with customers/group respresentatives to ensure understanding of administrative details and educating them on standard Membership Administration policies and procedures that impact installation decisions, escalating complex questions as needed; and providing quality customer service through communication with groups and members.
• Prepares system for new member enrollment by: entering and translating contractual information (e.g., product, plan, administrative details) associated with a sale and provided by the sales team into data attributes that are available in the membership system with minimal guidance; identifying gaps or inconsistencies in group purchase and renewal submissions, resolving standard issues in collaboration with partner teams (e.g., sales, case installation) and escalating issues as needed; developing standard and nonstandard structures and substructures in the system to accurately and comprehensively capture membership criteria; reviewing purchase details to ensure accuracy and completeness of contract provisions with minimal oversight; performing system testing for new products, system changes, and other customer/contract updates and escalating identified issues; and informing partners (e.g., sales, case installation) on best administrative approaches to achieve group/employer needs and requirements.

Minimum Qualifications

• Bachelors degree in Business, Health Care Administration, Operations Research, Public Health Administration, Finance, or related field AND minimum three (3) years of experience in compliance, financial insurance, health care administration, or a directly related field. OR Minimum six (6) years of experience in compliance, financial insurance, health care administration, or a directly related field.

Additional Requirements

• Knowledge, Skills, and Abilities (KSAs): Systems Thinking; Risk Management; Written Communication; Commercial Customer Quality; Maintain Files and Records; Data Entry; Union Partnerships; Advising and Managing Partners; Company Representation; Consulting; Coordination; Incident Escalation; Managing Complexity; Risk Assessment; Service Focus; Computer Literacy; Accountability; Autonomy; Stress Tolerance; Member Service; Insurance Coding; Insurance; Insurance Regulations, Policies, and Procedures; Insurance Contracts; Customer Satisfaction; Health Insurance Products; National/Multi-~State Sales and Account Management; Information Gathering; Business Acumen; Negotiation; Business Process Improvement; Operations Management; Stakeholder Management; Mentoring and Coaching; Project Management