Sr. Account Representative

Unite Here Health•Oak Brook, IL

9d•$28 - $34•Hybrid

About The Position

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!Responsible for processing complex enrollments, elections, and monthly contributions in accordance with Summary Plan Documents (SPDs) and Collective Bargaining Agreements to ensure member eligibility for health coverage. Duties include reconciling monthly work reports; processing COBRA enrollments, member payments, and QMCSOs (validation, agency response, dependent setup, and eligibility tracking).Manages a complex account portfolio, including self-pay, FMLA/vacation hours, hybrid contribution plans, and retiree dental plans, potentially across multiple regions. Supports intermediate regression testing, runs reports/queries, trains employers on ESS, and supports initial phases of OLE/HSP plans.Provides training and ongoing support to new hires and team members, conducts audit-based coaching, and handles escalated issues in the absence of the supervisor.Serves as a key point of contact for employers, Customer Service, Claims, Regional Directors, Audit, and Legal. Manages daily employer communications related to work reports, payments, eligibility, and new hires, with a strong working knowledge of contracts, SPDs, and Collective Bargaining Agreements.ESSENTIAL JOB FUNCTIONS AND DUTIESDetermines if the member plan provides access to dependent coverage, and meets the requirements of the QMCSOEnsures eligibility is updated timely to prevent problems with participants/dependents coverage seeking carePartners with vendors to update urgent eligibility requestsEscalates recurring issues that delay eligibility to managementApplies credits and debits accurately in systemMaintains all QMCSO and COBRA/HIPAA files, including enrollment and payment documentsMaintains and monitors employee elections and related co-premiumsMaintains, monitors and reviews proof documents (marriage certificates, divorce decrees, birth certificates, etc.) for dependent coverage and related contributionsUpdates member file in the eligibility system with terminated employees and new hire informationVerifies employer payments in US Bank to ensure all payments are processedMonitors employer reports and refers late employers to the Legal DepartmentMonitors outstanding balances and notifies employers of monthly discrepancies through written correspondence.Notifies members of payment discrepancies and cancellations through written correspondenceReviews the weekly and monthly COBRA & Health Insurance Portability and Accountability Act (HIPAA) eligibilityUpdates appropriate systems to track compliance and ensures that coverage is provided in accordance with the terms of the QMCSOTrains new hires on new processes and proceduresDocuments training provided and provides feedback to the staff and the management teamAudits accounts for purposes of coaching and development and provides feedback to the staff and management teamExemplifies the Funds BETTER Values and Professional Effectiveness Dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion

Requirements

High School Diploma
3 ~ 5 years of related experience
Working knowledge and experience in accounting, medical insurance, eligibility billing, delinquency procedures, reconciliation of payments, and collections
Preferable experience in eligibility rules including COBRA and Health Insurance Portability and Accountability Act (HIPAA), Employee Retirement Income Security Act (ERISA), and an understanding of Collective Bargaining Agreements

Responsibilities

processing complex enrollments, elections, and monthly contributions
reconciling monthly work reports
processing COBRA enrollments, member payments, and QMCSOs
managing a complex account portfolio
supporting intermediate regression testing
running reports/queries
training employers on ESS
supporting initial phases of OLE/HSP plans
providing training and ongoing support to new hires and team members
conducting audit-based coaching
handling escalated issues in the absence of the supervisor
serving as a key point of contact for employers, Customer Service, Claims, Regional Directors, Audit, and Legal
managing daily employer communications related to work reports, payments, eligibility, and new hires
determining if the member plan provides access to dependent coverage, and meets the requirements of the QMCSO
ensuring eligibility is updated timely to prevent problems with participants/dependents coverage seeking care
partnering with vendors to update urgent eligibility requests
escalating recurring issues that delay eligibility to management
applying credits and debits accurately in system
maintaining all QMCSO and COBRA/HIPAA files, including enrollment and payment documents
maintaining and monitoring employee elections and related co-premiums
maintaining, monitoring and reviewing proof documents (marriage certificates, divorce decrees, birth certificates, etc.) for dependent coverage and related contributions
updating member file in the eligibility system with terminated employees and new hire information
verifying employer payments in US Bank to ensure all payments are processed
monitoring employer reports and refers late employers to the Legal Department
monitoring outstanding balances and notifies employers of monthly discrepancies through written correspondence
notifying members of payment discrepancies and cancellations through written correspondence
reviewing the weekly and monthly COBRA & Health Insurance Portability and Accountability Act (HIPAA) eligibility
updating appropriate systems to track compliance and ensures that coverage is provided in accordance with the terms of the QMCSO
training new hires on new processes and procedures
documenting training provided and provides feedback to the staff and the management team
auditing accounts for purposes of coaching and development and provides feedback to the staff and management team
exemplifying the Funds BETTER Values and Professional Effectiveness Dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion