Enrollment Resolution Examiner- 004465 Jobs

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 Responsibilities/Accountabilities

• Serves as department representative on corporate projects as well as cross functional work groups as assigned, acting as a subject matter expert. Provides advice and counsel to project teams and leadership on implications of requirements based on regulatory guidance.
• Performs testing for the implementation of new products and work efforts.
• Assist with Quality Control for Membership by identifying quality risk, knowledge sharing with peers, and maintaining departmental level quality scores.
• Investigates, works, analyzes, tracks and monitors operational issues identified during the financial balancing adjustment of funds.
• Responsible for knowing regulatory guidelines and any associated updates.
• Regular and reliable attendance is expected and required.
• Receives, reviews and updates discrepancies from internal departments and external customers relating to the Membership subscriber/member/group files.
• Maintains necessary productivity and inventory reports and communicates as appropriate.
• Works continuously toward identifying and removing barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction.
• Reviews and adjusts payment of membership reports to ensure plan is paid correctly in order to maintain accurate financial records.
• Communicates with internal and external customers to request additional information as needed to assist with enrollment and billing processing or issue resolution.
• 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.
• 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.
• Provides supporting documentation and makes recommendations for procedure changes based on analysis completed.
• Analyze inventory data to identify gaps in process, trends, root cause and recommend a resolution for process efficiencies and associated changes.
• Initiates necessary requests of other operational areas to solve identified problems or recommendations for process improvement and execute resolution through completion.
• Independently reviews member and or group documentation and transactional updates to reconcile account discrepancies.
• Oversees control reports requiring enhanced research and resolution.
• Reconciliation of Regulatory and Health Plan Enrollment data through audit and review.
• Works on special projects and all third-party audits as necessary.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Verifies enrollment and billing accuracy and adjust as needed.
• Investigates and resolves discrepancies with appropriate documentation utilizing the internal and external guidelines/regulations/policies and procedures.
• Participates in Maintaining complete documentation for all activities involved in enrollment operations processes.
• 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.

Minimum Qualifications

Performs other functions as assigned by management

• Proven organizational, analytical, and time management skills.
• Must be flexible and able to adjust to rapidly changing priorities.
• Must have solid communication skills – both verbal and written.
• Strong attention to detail and accuracy.
• Computer proficiency, including experience in Microsoft Office Suite.
• Must be able to prioritize assignments and work accurately and independently within established time frames.
• A minimum of two (2) years health insurance operations experience preferred
• Associates Degree in Finance, Accounting, or similar discipline is required. In lieu of degree three (3) years’ experience with financial data, conducting financial analyses and recommendations, or related work experience and proven ability to exercise the requirements and responsibilities of the position required.
• Capable of establishing constructive relationships with all levels of internal and external of the organization.

Physical Requirements

• Ability to complete work in a traditional office environment under fluorescent lighting.
• 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.
• Ability to arrive on time at work and as scheduled.
• Must be able to travel across the enterprise.
• Ability to work in a home office for continuous periods of time for business continuity
• Ability to meet minimum performance metrics.

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural, and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

Our Company Culture

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

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