Account Specialist - Group Enrollment - (Menasha) in Appleton, Wisconsin For Sale

Network Health's success is rooted in its mission to enhance the life, health and wellness of the people we serve. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking an Account Specialist - Group Enrollment. This individual takes on a leadership role for all core functions of Group Administration. Responsible for communicating (in writing or verbally) with group contacts, members, agents, brokerage firms, and internal sales staff for the purpose of providing quality customer service. Audits and performs various enrollment/disenrollment changes, accounts receivable, collections, premium billing, and reconciliation duties for Network Health Plan. Serves as a resource for assisting the Associate Account Specialists in Group Administration. A qualified candidate will have a desire to work with a "values driven" organization while having the ability to communicate effectively, remain organized, and have ability to apply analytical thinking to identify and solve problems. Essential Job Duties: Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health. Takes the lead role in determining the status of eligibility, premium billing, collections (premium & rx), group reconciliation, cobra rights, student status eligibility and coordination of benefits (COB) based on policy provisions and state mandates. Possesses a thorough understanding of contracts, state mandates, legislative changes, and legal requirements for enrollment and billing. Assures that procedures, documentation and communication are such that risk of legal action is minimized. Responsible for handling extensive amounts of incoming and outgoing telephone calls with Network Health Plan's customer base including members, group contacts and brokers/agents. Responds promptly to all inquiries regarding administrative procedures and questions. Conducts audits of enrollment specialists, premium billing and group rating, eg, enrollments/disenrollments, status changes, rate adjustments and premium rate table assignments to employer group. Participates on Network Health's HOSHIN teams and Kaizen event teams as requested. Coordinates scenarios and testing for service pack installations and version upgrades to Network Health's operating system. Assists Manager, Group Enrollment in decision-making of exception requests made by employer groups, broker/agents and internal sales staff by supplying Manager with all relevant information related to the exception request. Administers individual and out-of-area conversion policies and benefits for applicable members. Tracks member's eligibility for continuation/conversion (COBRA) policies. Terminates membership and issues conversion policy information when eligibility expires. Coordinates monthly review of Informed Consent to Authorize Disclosure of Insurance Records forms whereby the authorization is due to expire. Generates correspondence to insured to renew/reject standing authorization and logs appropriate authorization on Orientates new department employees to Group Administration, eg provides education and hands on training for all key Group Administration functions, reviews guidelines and department procedures with employee, etc. Receives and updates all group changes within Network Health's Operating system from Sales department on a daily basis. Notifies Pharmaceutical Benefits Manager (PBM) to all new groups and administers the Online Eligibility software for member updates to PBM. Authorized to make manual billing adjustments and premium refunds with an approval limit up to $10,000. Drafts written correspondence or requests appropriate system form letters. Performs other duties and responsibilties as assigned. Skills Required: Working knowledge of COBRA regulations and group insurance contractual language. Ability to work under pressure & meet goals. Excellent verbal and written communication, analytical, and problem solving skills. Accurate data entry skills required. Critical & analytical thinking skills Good organizational skills Strong communication & interpersonal skills Minimum Education Required : Associate degree in Accounting or related program, or experience in related field. Minimum Related Years of Experience ( per minimum education ) Required: Group health insurance knowledge and HIAA or LOMA courses preferred. Minimum of 2-5 years combined enrollment/billing experience within the health insurance industry. Extensive experience with computer software, eg Microsoft Office products/applications. Company Description: Ministry Health Care is a network of hospitals, clinics, and other health related organizations operating across the central, northern, and northeastern regions of Wisconsin and eastern Minnesota. To meet the needs of the communities we serve, we offer a complete continuum of care through acute and tertiary care hospitals, physician clinics, long-term care and assisted living facilities, home health agencies, hospices, and numerous other programs and services.
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