Membership Eligibility Processor I, II, or III DOE
Cambia Health Solutions, Inc.
Remote
accounts
procedures
departmental
pc
remote
maintenance
high school
production
education
credit
data
identification
family
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September 24, 2022
Cambia Health Solutions, Inc.
Boise County, ID, Idaho City, ID, 83631
OTHER
Membership Eligibility Processor I, II, or III DOE Remote in WA, ID, and OR Primary Job Purpose: The Membership Eligibility Processor establishes and maintains accurate subscriber and member level eligibility through processing new applications, member additions and deletions, policy revisions, demographic changes, renewal changes, and any other maintenance affecting eligibility.
Normally to be proficient in the competencies listed below: This individual would have a high school diploma or GED and a demonstrated ability to meet or exceed accuracy and production standards, or an equivalent combination of education and job-related work experience.
Responsibilities: Process group enrollment applications for Individual, Small, Large, Trust, and Specialized groups.
Calculate appropriate waiting period credit, eligibility data, and effective date, and enter benefits, bank draft identification information, demographics, family members, and primary care physician information with network coding, while maintaining consistency with the contract in place.
Review, maintain and enter changes on Individual and/or Group & Trust accounts which may include change of effective date(s) for subscriber coverage or subscriber dependents, addition or deletion of insured or dependents from coverage, etc.
Acquire information required to complete application processing such as calling an employer, member or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan.
Meet MTM and State requirements by prioritizing work load and performing tasks accurately and timely.
Generate group or individual billings and order member ID cards.
Ensure current State and Federal policies and procedures are met by incorporating and applying essential changes made to Membership Accounting and Underwriting.
Meet established departmental performance expectations, including but not limited to ensuring member confidentiality.
Align with MTM standards as well as Consortium standards as they relate to group membership activities.
Handle responses to inquiries to meet BlueCross and BlueShield Association (BCBSA) standards and company goals.
Provide customer service to internal customers, and place/track outgoing calls to external customers including groups, agents and subscribers to acquire information vital to enrollment.
Review and apply eligibility rules for trust employees.
Assist newer team members with questions on complex issues or accounts as needed.
Assist Membership Lead and Supervisor as appropriate.
Maintain manuals to ensure policies and procedures are current.
Attend and participate in training and staff meetings.
Minimum Requirements: 40 wpm keying.
10-key by touch.
Must be meticulous and self-motivated and possess strong communication skills.
Must be dependable and maintain attendance at or above departmental standards.
Possess the ability to exercise judgment, initiative and discretion in a confidential, mature and sensitive manner.
Establish effective working relationships with staff and customers.
Possess basic math skills.
Ability to organize and prioritize work.
PC experience required; experience with Word, Excel, and Outlook or similar software.
Medical Terminology for WSHIP health questionnaire processors required.
Work Environment: Repetitive actions of using a PC keyboard and mouse.
Sitting at workstation for extended periods of time.
Willing to work overtime and on weekends when needed.
Normally to be proficient in the competencies listed below: This individual would have a high school diploma or GED and a demonstrated ability to meet or exceed accuracy and production standards, or an equivalent combination of education and job-related work experience.
Responsibilities: Process group enrollment applications for Individual, Small, Large, Trust, and Specialized groups.
Calculate appropriate waiting period credit, eligibility data, and effective date, and enter benefits, bank draft identification information, demographics, family members, and primary care physician information with network coding, while maintaining consistency with the contract in place.
Review, maintain and enter changes on Individual and/or Group & Trust accounts which may include change of effective date(s) for subscriber coverage or subscriber dependents, addition or deletion of insured or dependents from coverage, etc.
Acquire information required to complete application processing such as calling an employer, member or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan.
Meet MTM and State requirements by prioritizing work load and performing tasks accurately and timely.
Generate group or individual billings and order member ID cards.
Ensure current State and Federal policies and procedures are met by incorporating and applying essential changes made to Membership Accounting and Underwriting.
Meet established departmental performance expectations, including but not limited to ensuring member confidentiality.
Align with MTM standards as well as Consortium standards as they relate to group membership activities.
Handle responses to inquiries to meet BlueCross and BlueShield Association (BCBSA) standards and company goals.
Provide customer service to internal customers, and place/track outgoing calls to external customers including groups, agents and subscribers to acquire information vital to enrollment.
Review and apply eligibility rules for trust employees.
Assist newer team members with questions on complex issues or accounts as needed.
Assist Membership Lead and Supervisor as appropriate.
Maintain manuals to ensure policies and procedures are current.
Attend and participate in training and staff meetings.
Minimum Requirements: 40 wpm keying.
10-key by touch.
Must be meticulous and self-motivated and possess strong communication skills.
Must be dependable and maintain attendance at or above departmental standards.
Possess the ability to exercise judgment, initiative and discretion in a confidential, mature and sensitive manner.
Establish effective working relationships with staff and customers.
Possess basic math skills.
Ability to organize and prioritize work.
PC experience required; experience with Word, Excel, and Outlook or similar software.
Medical Terminology for WSHIP health questionnaire processors required.
Work Environment: Repetitive actions of using a PC keyboard and mouse.
Sitting at workstation for extended periods of time.
Willing to work overtime and on weekends when needed.
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