Billing Operations Specialist

Overview

A leading insurance provider specializing in dental and vision insurance is seeking a Billing Operations Coordinator to join their Operations team. This role is responsible for managing the full lifecycle of billing accuracy, payment file processing, partner analytics, and exception resolution across the member and carrier ecosystem. The coordinator will act as the key liaison between the enrollment platform, payment gateway, and carrier partners to ensure smooth billing operations and timely issue resolution.

Responsibilities

• Own billing exception identification, triage, and resolution from start to finish.
• Manage billing holds escalation and ensure issues are resolved promptly.
• Serve as the first line of response for billing-related tickets, maintaining accuracy and timeliness with an expected turnaround of 2 business days for approximately 10-15 tickets per week.
• Monitor daily payment declines and produce weekly decline trend reports by agency, product, and carrier.
• Identify and flag patterns proactively to prevent member or agency impacts.
• Process monthly payment files for all carriers and manage payment file implementation for new and existing carriers.
• Act as the primary connection point between the enrollment platform and payment gateway, ensuring data accuracy and continuity.
• Collaborate closely with Member Care, Operations, and carrier partners to communicate billing status, escalate unresolved issues, and keep stakeholders informed.
• Perform other duties as assigned.

Requirements

• Minimum of 1 year experience in billing operations, payment processing, insurance administration, or a related operational field; equivalent demonstrated capability will also be considered.
• Strong attention to detail with a proven ability to independently manage recurring processes accurately.
• Comfortable working with enrollment and billing platforms and able to quickly learn proprietary systems.
• Clear written communication skills for managing tickets, escalation notes, and cross-functional updates.
• Ability to manage multiple daily and weekly workstreams simultaneously without errors.
• Proactive and solution-oriented mindset, able to identify issues early and propose solutions.

Preferred Qualifications

• Experience with enrollment and payment gateway platforms such as E123 and NMI.
• Familiarity with ACH processing, payment file formats, or carrier billing workflows.
• Background in supplemental health, dental, vision, or insurance administration.
• Experience using AI tools like Claude or ChatGPT to support operational workflows, documentation, or exception management.

Success Metrics

• Within 90 days: Fully understand billing systems, carrier file schedules, exception workflows, and operational rhythms. Independently manage daily and weekly workstreams and ticket queues while recognizing decline and hold patterns.
• Within 180 days: Fully own workstreams, improve exception detection, contribute to process improvements, and serve as a dependable partner to Member Care and carrier teams. Achieve tighter billing accuracy and cleaner escalations.

Compensation & Benefits

• Company-paid health, dental, life, and disability insurance
• 401(k) plan with employer match
• Opportunities for professional development
• Work-from-home allowance and support
• Positive work environment
• Flexible remote and office-based work options within the United States

Location

Remote or office-based within the United States of America

Equal Opportunity

This employer is an Equal Opportunity Employer committed to building a diverse team that reflects a variety of backgrounds, perspectives, and skills to better serve members, agents, partners, and colleagues.