Research and Resolution Specialist

State of Oklahoma • Oklahoma City, OK

1d • Onsite

About The Position

The Research & Resolution Specialist is responsible for accurately processing forms, referrals, reports, and special projects, ensuring compliance with CMS PDP Guidance, EGID Rules and Regulations, and HIPM regulations. The role requires effective communication, problem-solving skills, and the ability to prioritize and manage various tasks to maintain the accuracy and efficiency of operations.

Requirements

• Knowledge of CMS Part D Program guidance, EGID rules and regulations, HIPAA privacy requirements, and other applicable state and federal compliance standards related to eligibility and benefits administration.
• Skilled in accurately processing forms, reports, referrals, queries, and eligibility updates within established timeframes and accuracy expectations.
• Ability to organize and prioritize daily, weekly, and monthly workload.
• Ability to maintain high productivity.
• Ability to identify and resolve discrepancies.
• Ability to use tracking systems to meet required deadlines.
• Ability to communicate clearly and professionally with internal and external customers.
• Ability to protect confidential information.
• Ability to collaborate with others to resolve issues.
• Demonstrate the Korn Ferry competencies of Ensures Accountability, Action Oriented, and Communicates Effectively.
• Application must include a resume/CV with complete work and education history.

Nice To Haves

• A bachelor’s degree.
• 2 years of experience in bookkeeping work, insurance eligibility determination or closely related work.
• 2 years of experience in the maintenance, analysis and reconciliation of insurance or benefits accounts.

Responsibilities

• Process all enrollment, change, and termination forms within five working days, maintaining established ranges of accuracy and productivity.
• Protect privacy and confidentiality of program participants' information and comply with HIPM regulations.
• Correctly process Medicare changes and notifications, as well as eligibility updates from Third Parties, within accuracy ranges and required time constraints, in compliance with current Center for Medicare & Medicaid Services (CMS) Part D Program (PDP) Guidance, EGID rules and regulations and all unit procedures.
• Handle urgent and non-urgent member and dependent eligibility and premium accounting referrals within accuracy ranges and required time constraints, adhering to all unit procedures and EGID rules and regulations.
• Review and process reports, queries, and other tasks, ensuring compliance with CMS PDP Guidance, EGID Rules and Regulations, and Unit and Member Accounts procedures.
• Create and mail letters regarding Active, Pre-Medicare and Medicare enrollments, changes, disenrollments, cancellations or changes within the required accuracy ranges and adhering to all CMS PDP guidance, federal guidelines and EGID rules.
• Complete special projects as assigned.
• Respond accurately to inquiries within established timeframes.
• Attend recurring unit/department/division/agency meetings and any mandatory trainings provided by Member Accounts leadership or Human Resources.
• Other duties as assigned.

Benefits

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level