Insurance Reconciliation Specialist

isolved•,

18h

About The Position

The Insurance Reconciliation Specialist is responsible for performing high-volume, back-end insurance data reconciliation. This role focuses on the accurate processing and validation of large datasets, identifying discrepancies, and taking appropriate corrective action to ensure billing accuracy and enrollment integrity within the isolved system. The role also includes calculating self-bills and broker commissions, submitting payment requests to the Finance and Treasury teams, and maintaining close collaboration with those teams to ensure timely and accurate financial processing.

Requirements

Bachelor's degree or equivalent work experience in the benefits, finance, or accounting field
2–4 years of benefits auditing/reconciliation experience, preferably involving large data volumes
Experience calculating self-bills and/or broker commissions
Experience submitting payment requests or working within accounts payable, finance, or treasury workflows
Demonstrated ability to identify discrepancies in data and take independent corrective action
Experience with or strong aptitude for AI tools, automation, and data analysis technologies
Software experience, preferably in a SaaS environment
Strong computer skills, including all MS Office software, internet navigation, and database usage
Demonstrated success in a role requiring strong attention to detail and initiative
Demonstrated strong technical aptitude and capabilities
Superior problem-solving skills
Basic understanding of payroll processing and principles
Excellent written and verbal communication skills, including fluency in English
Exceptional organizational, planning, and prioritization skills

Responsibilities

Reconcile large volumes of insurance billing and enrollment data each month to identify discrepancies and validate accuracy against the isolved system and actual deductions taken.
Analyze reconciliation data independently and take decisive corrective action when discrepancies are found, including updating enrollments, terminations, and enrollment changes in isolved and insurance carrier sites.
Calculate self-bills and broker commissions accurately based on enrollment data and carrier terms.
Submit bill pay requests and commission payment requests to the Finance team for processing in a timely manner.
Collaborate with the Treasury team to ensure payment submissions are accurate, complete, and processed within required deadlines.
Research and resolve inaccuracies and variances identified during audits; document findings and actions taken.
Communicate recommended changes and solutions to appropriate internal contacts and insurance brokers when necessary.
Correspond with carriers on required enrollment changes or billing statement questions.
Collaborate with 3rd party vendors and/or the internal EDI/Carrier Connect team on issues related to files being sent or received by carriers.
Validate benefit plan configuration accuracy and alignment with carrier specifications; partner with internal benefits and implementation teams on plan builds, updates, and related questions.
Manage various benefit plan information (FSA, medical, dental, vision, life, disability, etc.) to complete audits and ensure plan setup is not contributing to discrepancies.
Leverage AI tools and automation to support data analysis, pattern recognition, and reconciliation workflows.
Ensure deadlines for audits, self-bills, commissions, and bill payments are met, escalating issues appropriately.
Collaborate with peers to establish and improve back-end reconciliation best practices.
Complete special projects as needed.