Other Health Insurance (OHI) Associate - Remote
About The Position
Other Health Insurance (OHI) Associate is responsible for researching, verifying, maintaining, and updating member Other Health Insurance (OHI) information to ensure accurate coordination of benefits, claims processing, and enrollment records. Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
Requirements
- High School Diploma or GED REQUIRED
- 2 years of Health Plan Claims Disbursements REQUIRED
Nice To Haves
- Knowledge of OHI Businesses.
- Experience in insurance, enrollment, claims, customer service, or data-entry experience.
- Proficiency with Microsoft Office products
- Strong attention to detail and problem-solving skills.
- Experience with QNXT, Facets, CSC, or similar healthcare systems.
- Healthcare payer or managed care experience.
- Healthcare insurance knowledge
- Data integrity and accuracy focus
- Critical thinking skills
- Attention to Detail
- Accuracy and Timeliness
- Strong communication skills with the ability to engage on phone calls for research and resolution of OHI inquiries
- Communicate complex information clearly and concisely.
- Ability to work independently and take ownership of assigned work
- Ability to work collaboratively with team members for their shared goals
- Ability to manage multiple priorities
- HIPAA Compliance
- Ability to follow SOP and Job Aids and apply them.
Responsibilities
- Research, verify, and update member OHI information.
- Validate OHI for Sentara Commercial, Medicare, and Medicaid members.
- Determine the Payer Order between coverages.
- Investigate OHI inquiries.
- Complete assigned work queues within SLA requirements.
- Participate in user training and knowledge share sessions, and retain and apply.
Benefits
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
