Job Description:

Summary:

The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas.

Essential Primary Responsibilities/Accountabilities:

• Verifies enrollment and billing accuracy and adjust as needed.
• Prepares regular and periodic reports for the review and assurance of following processing guidance including but not limited to, the operations reporting of all transactions.
• Investigates, works, analyzes, tracks and monitors operational issues identified during the financial balancing adjustment of funds.
• Initiates necessary requests of other operational areas to solve identified problems or recommendations for process improvement and execute resolution through completion.
• Provides supporting documentation and makes recommendations for procedure changes based on analysis completed.
• Independently reviews member and or group documentation and transactional updates to reconcile account discrepancies.
• Receives, reviews and updates discrepancies from internal departments and external customers relating to the Membership subscriber/member/group files.
• Reconciliation of Regulatory and Health Plan Enrollment data through audit and review.
• Communicates with internal and external customers to request additional information as needed to assist with enrollment and billing processing or issue resolution.
• Assist with Quality Control for Membership by identifying quality risk, knowledge sharing with peers, and maintaining departmental level quality scores.
• Oversees control reports requiring enhanced research and resolution.
• Analyze inventory data to identify gaps in process, trends, root cause and recommend a resolution for process efficiencies and associated changes.
• Performs testing for the implementation of new products and work efforts.
• Maintains necessary productivity and inventory reports and communicates as appropriate.
• Reviews and adjusts payment of membership reports to ensure plan is paid correctly in order to maintain accurate financial records.
• Investigates and resolves discrepancies with appropriate documentation utilizing the internal and external guidelines/regulations/policies and procedures.
• Participates in Maintaining complete documentation for all activities involved in enrollment operations processes.
• Works on special projects and all third-party audits as necessary.
• Works continuously toward identifying and removing barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction.
• Responsible for knowing regulatory guidelines and any associated updates.
• Mentors and collaborates with others on the team in utilizing tools, sharing best practices, and serving as a role model within a team unit structure.
• Serves as department representative on corporate projects as well as cross functional work groups as assigned, acting as a subject matter expert. Provides advice and counsel to project teams and leadership on implications of requirements based on regulatory guidance.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required. Performs other functions as assigned by management

Minimum Qualifications:

• Associates Degree in Finance, Accounting, or similar discipline is required. In lieu of degree three (3) years' experience with financial data, conducting financial analyses and recommendations, or related work experience and proven ability to exercise the requirements and responsibilities of the position required.
• A minimum of two (2) years health insurance operations experience preferred
• Capable of establishing constructive relationships with all levels of internal and external of the organization.
• Must be able to prioritize assignments and work accurately and independently within established time frames.
• Must be flexible and able to adjust to rapidly changing priorities.
• Must have solid communication skills - both verbal and written.
• Proven organizational, analytical, and time management skills.
• Computer proficiency, including experience in Microsoft Office Suite.
• Strong attention to detail and accuracy.

Physical Requirements:

• Ability to complete work in a traditional office environment under fluorescent lighting.
• Ability to arrive on time at work and as scheduled.
• Ability to meet minimum performance metrics.
• Ability to orally communicate.
• Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time.
• Must be able to travel across the enterprise.
• Ability to work in a home office for continuous periods of time for business continuity

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade 111: Minimum: $21.83 - Maximum: $34.92

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity

Minimum Salary: 0.00 Maximum Salary: 0.00 Salary Unit: Yearly