Group Accounts Representative

Delta Dental of Missouri • Sunset Hills, MO

4d • Hybrid

About The Position

We're hiring a Group Accounts Representative to manage group setup, eligibility, billing, and ID card distribution. This client-facing role ensures accurate account data and smooth onboarding through electronic file troubleshooting. You'll also monitor account balances, resolve payment issues, and support financial accuracy. If you’re detail-oriented and experienced in health benefits operations, we’d love to hear from you. Apply now to join a collaborative team in a hybrid work environment!

Position Summary:

The primary responsibility of the Group Accounts Representative is to set up and maintain groups in the system including eligibility, rates, billing standards and web access. This role is also responsible for generating and distributing ID cards for all accounts. In addition, this role troubleshoots issues with the initial electronic files during the new client onboarding process.

The Group Accounts Representative monitors and reconciles client account balances. This role is a client-facing position that includes communicating directly with clients regarding eligibility issues, billing issues, account payments and other service-oriented issues related to eligibility and receivables.

Requirements

• High School diploma or equivalent required
• Minimum of 3 years’ experience in the health benefits arena, preferably in operations, receivables, or reconciliation processes
• Proficiency in Microsoft Word, Excel, and Outlook
• Advanced problem-solving and decision-making abilities
• Exceptional verbal and written communication skills
• Ability to collaborate effectively with customers, colleagues, and leadership at all levels.

Responsibilities

• Establishes and maintains groups information including the setup for eligibility, rates, billing standards and web access. This work may include but is not limited to: • Loading and maintaining accurate eligibility and premium rates into the administration system. • Ensuring accuracy for rate setup and billing standards. • Determining the appropriate system changes needed to script for policies. • Testing group setup and ensuring the accuracy of systems based on policy requirements. • Setting up COB, dual Delta and member merge eligibility for appropriate claims payments. • Validating, assigning, and managing client user web access for processing eligibility, billing and retrieving premium billing invoices. • Notifying EDI team to load initial eligibility and validate for the ID card process. • Terminating eligibility and billing processes including reconciliation for final billing.
• Troubleshoots issues with electronic eligibility files. This work may include but is not limited to: • Collaborating with the EDI team to address issues with electronic eligibility files. • Reviewing error reports and contacting clients for missing information to complete enrollment processing. • Identifying file issues and recommending solutions to clients.
• Supplies groups with timely and accurate ID cards. This work includes but is not limited to: • Monitoring the production and distribution process for ID cards on all accounts. • Researching questions or issues related to ID cards. • Ensuring accurate and on-time delivery of all ID cards within a group. • Coordinating with the Group Accounts Supervisor on custom ID cards.
• Communicates with clients regarding account balances, ID cards, eligibility questions and other file issues. This work may include but is not limited to: • Providing professional and consistent updates on the receipt of electronic eligibility files and the setup of account eligibility and ID cards. • Contacting clients to provide responses to questions and solutions to issues related to eligibility, web access or billing. • Collaborating with Account Managers to ensure strong communication for shared accounts. • Responding to calls and emails within a timely manner to ensure a positive client experience.
• Monitors and reconciles account balances to ensure accuracy and payment on accounts. This work may include but is not limited to: • Monitoring receivable balances to ensure timely payments and research disputed or unreconciled account balances. • Addressing account balance issues with clients to ensure resolution. • Drafting delinquency letters and monitoring collection proceeding on balances. • Suspending accounts or initiating cancellation requests due to non-payment, in accordance with company guidelines, to ensure claim payments are placed on hold until the account is resolved. • Validating that self-billed client payments fall within the established exception thresholds, processing necessary adjustments and true-up billing to ensure account accuracy. • Reporting payment discrepancies to the Finance department for corrections.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED