Enrollment & Billing Specialist III

The Enrollment and Billing Specialist III is able to perform the duties of both the E&B Specialist I and II. Research, resolve and respond to complex issues and concerns on behalf of both internal and external customers. Maintain accurate and up-to-date membership records to ensure correct premium billing and claim processing within contract limits. Calculate and process refunds in FACETS and coordinate with the Accounting Dept for disbursement. Research and respond to internal high-priority cases or urgent inquiries. Work cohesively in a team and shift work tasks and priorities as needed.

• This role does not manage people
• This role reports to this job: SUPERVISOR, ENROLLMENT & BILLING
• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:
  
  Accounting, Actuarial, BET, Claims, Compliance, Customer Service, Finance, Legal, Sales and Marketing, Underwriting, IT, District Offices, Producers, Group Leaders, Brokers, 834 vendors and all levels of Enrollment and Billing personnel and other BCBSLA departments as needed.

• High School Diploma or equivalent is required
• Associate's is preferred

Work Experience

• 4 years of clerical experience is required
• 2 years of Enrollment and Billing experience across different E&B units is required
• Required experience can run concurrently  
• Customer Service or Marketing experience is preferred

• Must have thoroughly understand insurance and working knowledge of enrollment and billing functions and FACETS system.
• Must be able to identify compliance issues and complex business needs, develop solutions and resolve problems.
• Must be able to coordinate with other internal departments as part of Triage Team to ensure that all required customer information is gathered comprehensively for all internal parties involved as early in the process as possible. Consolidate and communicate data requests back to the Group Leader.
• Must have working knowledge of relevant software (e.g., MS Word, Excel, Outlook, etc.) and related software as well as other corporate programs and applications and the ability to learn new systems.
• Must have thorough knowledge to apply company policies and procedures, company guidelines, state and federal laws and mandates (e.g., HIPPA, COBRA, PPACA, etc.) to ensure information is current and accurate.
• Must demonstrate verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
• Must be able to prioritize multiple responsibilities, make decisions, find solutions and work independently in order to meet aggressive deadlines, and adapt to a fast-paced, changing environment.
• Able to cohesively work in a team environment to ensure efficient and effective completion of all tasks for assigned groups.
• Must have strong organizational and analytical abilities and effective interpersonal skills. Must be able to recognize inconsistencies and gaps in business processes and take appropriate actions.
• Must possess a positive attitude which embraces customer-centric behavior, organizational cultural beliefs, company values as well as divisional requirements including efficiency, accuracy, productivity, and/or work schedule and confidentiality of information. Must be flexible to shift priorities as needed to cover multiple tasks in the process as directed by the Supervisor.
• Must have working knowledge about plan products, company initiatives and other operational changes affecting the department.
• Must be punctual and have regular attendance.
• Must be able to work overtime during peak enrollment and renewal season.

• None Required

• Duties of an Enrollment and Billing Specialist I and II
• Serve as the subject matter expert with thorough knowledge of enrollment and billing processes including company policies and procedures, compliance guidelines, and state and federal laws and mandates (e.g., HIPPA, COBRA, PPACA, etc.). Work with Legal, DOI, and Compliance Specialists to ensure issues/cases that come form DOI are submitted in a timely manner.
• Coordinate with Underwriting, Marketing, and Enrollment as part of the Triage team to effectively collect all required information as early in the process and minimize hand-offs and loop backs to customers and other parties for additional information s well as streamline the lockout process.
• Serves as the point of contact for high priority inquiries and complaints to expedite the research and resolution accurately and in a time manner.
• Coordinate internal or external fact-gathering meetings for issue resolution as needed and take minutes of the meeting to present to management.
• Maintain working relationships with internal stakeholders and customers. This may include on-site visits and travel.
• Calculate and process refunds, along with process the reinstatements and generate letters.
• Analyze internal and external reports.
• Ensure processing of reconciliation to maintain accurate policy records. Process premium-related charges, terminations/cancellations, and/or issues.
• Perform reconciliations and audits.
• Meet quality/production standards as determined by leadership
• Perform self-audit and peer-audit procedures and complete related quality control documents and work management processes. Account for policies and procedures including compliance with state, federal, and departmental policies. Resolve all enrollment and invoice billing issues.
• Identify inefficient or ineffective processes and offer process improvement plans.
• Comply with all laws and regulations associated with duties and responsibilities

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.