Primary Job Purpose
The Membership Administrator I establishes and maintains eligibility, bills premium, reconciles cash and member discrepancies, pursues aged accounts and provides eligibility and billing related customer service for Individual, Group, Government Programs, Cobra and Flexible Spending business.
General Functions and Outcomes
- Process Individual, and/or small, large or specialized group enrollment applications. Calculate appropriate waiting-period credit, eligibility data, effective date, and enter benefits, bank draft identification information, name, social security number, address, family members and primary care physician information with network coding, which is consistent with the employer/individual contract.
- Review, maintain and enter changes on individual and/or group accounts which may include change of effective date(s) for insured coverage or members, addition, or deletion of insured or members from coverage, etc.
- Reviews requests for completeness of information and identifies additional information needed to initiate the request. This could include placing, receiving and documenting calls to acquire information required to complete application processing such as calling an employer or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan.
- Provide customer service to internal and external customers by supplying information through written correspondence and responding to telephone inquiries. Make any necessary corrections or adjustments.
- Perform all eligibility and reconciliation tasks accurately and timely for assigned business segment, adhering to established procedures including identification of discrepancies between payment and amount invoiced.
- Generate group or individual billings. Review billings and ensure accuracy before distributing.
- Order member cards and audit these against the member applications for accuracy, correct corporate logos, lines of business co-pay, PCP, and any member card comments.
- Appropriately apply corporate underwriting and governmental guidelines and policies in eligibility processing.
- Ensure cash is processed through daily reconciliation to achieve established cash turnaround standards.
- Identify and prioritize work in order to meet deadlines and compliance timeframes.
- Monitor, pursue and report on aged accounts to ensure amounts are accurate and cleared in time to meet goal of achieving corporate standards.
- For Government Programs related jobs, gain working knowledge of State and Federal regulations.
- Incorporate and apply changes made to Membership Accounting, Underwriting or State and Federal policies and procedures to ensure current requirements are met.
- Adheres to dependability, customer focus, and all performance criteria as established by the department including timeliness, production, and quality standards for all work.
- Ensure member confidentiality in all aspects of eligibility and billing processes.
- Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality, and compliance with federal, state, BCBSA and accreditation regulations. Follows approved policies and procedures needed to accomplish this and provide any necessary changes to documentation.
- Uses knowledge and understanding to research simple to moderately sophisticated documentation and requests. Coordinates transfer and receipt of electronic data as applicable with various outside entities including CMS, employer groups, agents, and vendors.
- Assist with user acceptance and system integration testing.
- Work overtime and on weekends, as required.
- Perform various clerical tasks.
- Backup other staff members by providing phone coverage and assisting with mail, filing and other special projects.
- Attend and participate in training and staff meetings.
Normally to be proficient in the competencies listed above
- 30 wpm with 95% accuracy typing skills.
- 10-key by touch (8500 keystrokes per hour with 95% accuracy preferred).
- PC experience - Word, Excel and Outlook - or comparable software - and ability to learn and use complex systems.
- Strong math skills (mathematical calculations and concepts), judgment and other resources to implement effective problem solving.
- Ability to coordinate and prioritize work.
- Must be diligent and self-motivated.
- Must be conscientious and maintain attendance at or above departmental standards.
- Ability to exercise judgment, initiative and discretion in confidential, mature and sensitive manner.
- Ability to communicate effectively both orally and in writing.
- Ability to establish effective working relationships with staff and customers
The Membership Administrator I would have a High School diploma or GED and one-year accounts receivable or customer billing experience or an equivalent combination of education and job-related work experience.Work Environment
- Duties performed primarily in an office environment.
- Travel may be required.
- Repetitive actions of utilizing a PC keyboard and mouse.
- Sitting at workstation for extended periods of time.
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:
- medical, dental, and vision coverage for employees and their eligible family members
- annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
- paid time off varying by role and tenure in addition to 10 company holidays
- up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
- up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
- one-time furniture and equipment allowance for employees working from home
- up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.