Enrollment Resolution Examiner I

company•Town of Kirkland, NY

4d•$21 - $35

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 role works across multiple Enrollment operational areas under management direction and in accordance with Health Plan objectives and policies and State and Federal guidelines. At Level I, the examiner audits and reviews regulatory and Health Plan Enrollment data, resolves discrepancies in member and group records, investigates operational issues identified during financial balancing, prepares operational reports, and works with internal and external customers and other operational areas to resolve problems and recommend process improvements. The examiner must be proficient in one line of business and able to process inventory from other lines of business as requested. At Level II, in addition to Level I responsibilities, the examiner mentors and supports team members, serves as a subject matter expert in one line of business, and applies working knowledge across other inventory areas. The role supports implementation of new processes and procedures, including testing and documentation, and represents Enrollment Resolution in corporate projects and cross-functional work groups. The position requires work in an office or home-office setting, the ability to travel across the enterprise, and extended computer use. Compensation is listed as $21.20–$33.03 per hour for Level I and $22.50–$35.00 per hour for Level II. The posting notes that remote work may be available on a case-by-case basis.

Requirements

Conducting financial analyses and recommendations, or related work experience, with demonstrated 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 contacts 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.
Organizational, analytical, and time-management skills.
Computer proficiency, including experience with Microsoft Office Suite.
Strong attention to detail and accuracy.
Ability to complete work in a traditional office environment under fluorescent lighting.
Ability to arrive at work on time and as scheduled and meet minimum performance metrics.
Ability to communicate orally.
Ability to sit at a desk and use a computer, keyboard, and mouse for three or more hours at a time.
Ability to travel across the enterprise.
Ability to work in a home office for continuous periods for business continuity.

Nice To Haves

For Level II, a minimum of five years of health insurance operations experience is preferred.
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, demonstrated ability to support and train peers.

Responsibilities

Reconcile regulatory and Health Plan Enrollment data through audits and reviews using applicable guidelines, regulations, policies, and procedures.
Use reporting and regulatory guidance to verify enrollment and billing accuracy and help ensure the plan is paid correctly.
Ensure member and group documentation and transactional updates are completed to reconcile account discrepancies.
Receive, review, and update discrepancies involving Membership subscriber, member, and group files from internal departments and external customers.
Investigate, analyze, track, and monitor operational issues identified during financial balancing adjustments.
Participate in process and technology improvements to increase productivity, quality, cost effectiveness, timeliness, and customer satisfaction.
Prepare regular and periodic reports to support compliance with processing guidance, including transaction reporting.
Initiate requests to other operational areas to resolve problems or recommend process improvements.
Communicate with internal and external customers, provide supporting documentation, and recommend procedure changes based on analysis.
Maintain member privacy in accordance with corporate privacy policies and procedures, and uphold the organization’s mission, values, and Code of Conduct.
Process inventory from other lines of business as requested while maintaining proficiency in one line of business.
At Level II, mentor and support team members by answering questions, demonstrating tasks, reviewing work, sharing best practices, and serving as a role model.
At Level II, support implementation of new processes and procedures, including creating test cases and documents, testing processes, conducting end-user testing, and establishing procedures.
At Level II, represent Enrollment Resolution on corporate projects and cross-functional work groups, advising project teams and leadership on requirements.