Membership Administrator I, II, or III DOE

Cambia Health Solutions • Medford, OR

1d • $18 - $31 • Remote

About The Position

Every day, Cambia's dedicated The Membership Administrator I, are living our mission to make health care easier and lives better. As a member of the Customer & Member Services Operations team, our The Membership Administrator I establishes and maintains eligibility, bills premium, reconciles cash, pursues aged accounts and provides eligibility and billing related customer service for Individual, Group, Government Programs, Cobra and Flexible Spending business, all-in service of creating a person-focused health care experience. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

Requirements

• High school diploma or GED required
• Minimum one year of accounts receivable or customer billing experience
• Equivalent combination of education and job-related work experience will be considered
• 30 wpm with 95% accuracy typing skills
• PC experience with Word, Excel, and Outlook (or comparable software) and ability to learn and use complex systems
• Strong math skills including mathematical calculations and concepts, with effective judgment and problem-solving abilities
• Ability to organize and prioritize work while maintaining detail-oriented focus and self-motivation
• Dependable attendance at or above departmental standards with ability to exercise judgment, initiative, and discretion in confidential and sensitive matters
• Effective oral and written communication skills with ability to establish positive working relationships with staff and customers

Nice To Haves

• 10-key by touch with 8500 keystrokes per hour at 95% accuracy preferred

Responsibilities

• Process and manage enrollment applications for individuals and groups of all sizes, including calculating waiting-period credits, eligibility data, and effective dates; enter comprehensive member information (benefits, bank draft details, personal data, family members, PCP information with network coding) consistent with employer/individual contracts; review, maintain, and process account changes including coverage effective dates, member additions/deletions, and other modifications
• Conduct proactive communication and verification by placing, receiving, and tracking calls to employers, agents, subscribers, and previous carriers to obtain required information for application processing, such as verifying hire dates, benefit selections, and prior coverage effective dates; provide exceptional customer service to internal and external customers through written correspondence and telephone inquiries, making necessary corrections and adjustments
• Execute eligibility and reconciliation tasks accurately and timely for assigned business segments, adhering to established procedures; identify discrepancies between payments and invoiced amounts; generate and review group or individual billings for accuracy before distribution; ensure cash processing through daily reconciliation to meet established turnaround standards; monitor, pursue, and report on aged accounts to meet corporate standards
• Manage member card operations and quality assurance by ordering member cards and auditing them against applications for accuracy, including verification of corporate logos, lines of business, co-pays, PCPs, and member card comments; ensure member confidentiality in all aspects of eligibility and billing processes
• Apply and maintain compliance with corporate underwriting guidelines, governmental regulations, and policies in eligibility processing; for Government Programs roles, develop working knowledge of State and Federal regulations; incorporate and apply changes to Membership Accounting, Underwriting, or State and Federal policies to ensure current requirements are met; comply with MTM, Consortium, or Governmental quality and timeliness standards to meet BlueCross BlueShield Association or CMS standards
• Coordinate data management and system operations by managing transfer and receipt of electronic data with external entities including CMS, employer groups, agents, and vendors; assist with user acceptance and system integration testing; identify and prioritize work to meet deadlines and established departmental performance expectations
• Provide operational support and flexibility by working overtime and weekends as necessary; perform various clerical tasks; backup staff members through phone coverage, mail handling, filing, and special projects; attend and actively participate in training sessions and staff meetings

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees