Mem Maintenance Technician

Blue Cross Blue Shield of Michigan•Detroit, MI

22h•Onsite

About The Position

Update and maintain accuracy of the membership database. This includes, but is not limited to, processing electronic work queues, SF’s, membership applications, PCP selection processing, membership changes submitted from employer groups via printed reports and any membership data base auditing and reports. Proactively manage PCP selection and membership errors for all groups. Responsible for interacting directly with employer group representatives, BCBSM Sales and Marketing staff, agents and Third-Party Administrator’s (TPA) to identify and resolve inquiry-servicing issues. Process electronic write-off queues, SF’s, paper applications, PCP selections, group submitted reports, and system produced reports. Contact employer group when necessary to obtain needed information to process membership/PCP changes. Document contact through BCN’s customer tracking/imaging/workflow system. Receive and respond to inquiry-servicing issues from employer group representatives, BCBSM Sales and Marketing staff, agents and TPA’s. Process errors resulting from automated processes (Generic membership loads, write-offs, pre-billing error reports, pre-capitation error reports, automated PCP selection process, etc.). Periodically conduct system membership audits (i.e. employer group specific audits). Maintain consistent rapport with Group Account Analyst and Sr Group Account Analyst when questions/concerns arise regarding documentation received from employer groups. Maintain Inventory Tracking database. Maintain Workforce Management Tools system for production control including the input of data and working of regular reports. Other duties as assigned by leadership of Membership and Billing. Participate in corporate committees and work groups.

Requirements

High School diploma or GED required.
Two (2) years of prior work experience in general office processes or customer service required.
Excellent verbal and written communication skills required.
Strong analytical and mathematical skills required.
Excellent organizational skills with the ability to work independently while handling multiple projects and timelines required.
Data entry requirement of 90 NKPM with 99% accuracy required.

Nice To Haves

Associate degree or two (2) years of full-time college credits preferred.
One (1) year experience in a managed care setting preferred.
Basic knowledge of membership underwriting guidelines preferred.
Basic knowledge of HMO’s and capitation procedures preferred.
Knowledge PC software applications used for word processing and spreadsheets preferred.
Knowledge of BCN/BCBSM membership and billing systems preferred.
Knowledge of MACESS imaging system preferred.
Intermediate knowledge of Microsoft Word and Excel preferred.

Responsibilities

Update and maintain accuracy of the membership database.
Process electronic work queues, SF’s, membership applications, PCP selection processing, and membership changes submitted from employer groups via printed reports.
Conduct membership database auditing and reports.
Proactively manage PCP selection and membership errors for all groups.
Interact directly with employer group representatives, BCBSM Sales and Marketing staff, agents, and Third-Party Administrators (TPA) to identify and resolve inquiry-servicing issues.
Process electronic write-off queues, SF’s, paper applications, PCP selections, group submitted reports, and system produced reports.
Contact employer groups to obtain necessary information for membership/PCP changes.
Document contact through BCN’s customer tracking/imaging/workflow system.
Receive and respond to inquiry-servicing issues from employer group representatives, BCBSM Sales and Marketing staff, agents, and TPA’s.
Process errors resulting from automated processes.
Periodically conduct system membership audits.
Maintain consistent rapport with Group Account Analyst and Sr Group Account Analyst regarding documentation from employer groups.
Maintain Inventory Tracking database.
Maintain Workforce Management Tools system for production control.
Participate in corporate committees and work groups.