Enrollment Resolution Examiner I

Univera Healthcare•Buffalo, NY

About The Position

The Enrollment Resolution Examiner resolves complex enrollment and billing reconciliation issues between the Health Plan and external customers, including State and Federal Government Agencies. The work is performed under the general direction of management and in accordance with Health Plan objectives and policies, as well as applicable State and Federal guidelines. The role works across multiple Enrollment operational areas. Level I examiners reconcile regulatory and Health Plan enrollment data through audit and review, using applicable guidelines, regulations, policies, and procedures. They review and update discrepancies in membership subscriber, member, and group files; investigate and monitor operational issues arising from financial balancing adjustments; and help ensure enrollment and billing accuracy and accurate financial records. They also prepare reports, coordinate with other operational areas to address problems, communicate findings to internal and external customers, and recommend procedural improvements. Level II examiners perform all Level I responsibilities and additionally mentor team members, provide subject matter expertise, support implementation and testing of new processes, and represent Enrollment Resolution on corporate projects and cross-functional work groups. The role supports the organization's mission and values, follows its Code of Conduct and privacy policies, and may process inventory across lines of business.

Requirements

Experience conducting financial analyses and making recommendations, or related work experience demonstrating the ability to perform the position's responsibilities.
Three years of experience with financial data or Health Insurance Enrollment experience, or an associate degree in finance, accounting, or a similar discipline.
Ability to establish constructive relationships with internal and external stakeholders at all organizational levels.
Ability to prioritize assignments and work accurately and independently within established time frames.
Flexibility to adjust to rapidly changing priorities.
Solid verbal and written communication skills.
Proven organizational, analytical, and time-management skills.
Computer proficiency, including experience with Microsoft Office Suite.
Strong attention to detail and accuracy.
For Level II, ability to independently represent the department as a subject matter expert in discussions with other company areas.
For Level II, in-depth regulatory and Enrollment process knowledge in one line of business and working knowledge in an additional line of business.
For Level II, proven ability to support and train peers.

Nice To Haves

For Level II, a minimum of five years of health insurance operations experience is preferred.

Responsibilities

Reconcile regulatory and Health Plan enrollment data through audits and reviews using applicable guidelines, regulations, policies, and procedures.
Use reporting and regulatory guidelines to verify enrollment and billing accuracy and help ensure the plan is paid correctly.
Ensure member and/or group documentation and transactional updates are completed to reconcile account discrepancies.
Receive, review, and update discrepancies reported by internal departments and external customers concerning membership subscriber, member, and group files.
Investigate, analyze, track, and monitor operational issues identified during financial balancing adjustments.
Participate in process and technology improvement efforts to increase productivity, quality, cost effectiveness, timeliness, and customer satisfaction.
Prepare regular and periodic reports to support adherence to processing guidance, including reports on transactions.
Initiate requests to other operational areas to resolve identified problems or recommend process improvements.
Communicate with internal and external customers, provide supporting documentation, and recommend procedure changes based on completed analysis.
Demonstrate integrity, support the organization's mission and values, follow its Corporate Code of Conduct, and maintain member privacy in accordance with corporate policies and procedures.
Maintain proficiency in one line of business and process inventory from other lines of business as requested.
At Level II, mentor and collaborate with teammates by sharing best practices, demonstrating tasks, answering questions, and reviewing work.
At Level II, support implementation of new processes and procedures, including creating test cases and documentation, testing processes, conducting end-user testing, and establishing procedures.
At Level II, represent Enrollment Resolution on corporate projects and cross-functional work groups, providing subject matter expertise, advice, and counsel to project teams and leadership.