Membership Specialist II

Overview

This role is a Telecommuter position performing moderate to complex reconciliation analysis and audit activities for Individual or Group accounts receivable. Responsibilities include resolving enrollment, reconciliation, and billing issues with minimal supervision and contributing to coaching internal and external customers on contractual guidelines. Work supports financial risk management and customer satisfaction.

Responsibilities

• Identify, resolve, and document complex reconciliation discrepancies independently.
• Process refunds, premium transfers, reinstatements, and insufficient funds issues as needed.
• Process new enrollment and/or eligibility changes and maintain accurate, comprehensive notes.
• Validate appropriate accounts receivable by conducting detailed reconciliation and audits of group or individual premiums and membership of moderate to complex difficulty.
• Use various tools and appropriate system reports (e.g., Access or Excel) to support updates to eligibility, enrollment, and/or reconciliation of accounts.
• Meet or exceed department metrics, including production and quality standards, and stay current on departmental policies and procedures.
• Create written correspondence letters using the appropriate system regarding billing and enrollment issues.
• Research, investigate, and resolve complex account discrepancies, including premium rate issues, bill flag suspension and/or corrections, and billing issues.
• Reproduce and create customized or manual bills as needed or requested; ensure timely and accurate maintenance and reporting of inventories.
• Partner with internal/external partners and members to review and resolve issues, which may include web portal usage and contract interpretation.
• Conduct complex electronic file accounts receivable and enrollment reconciliation.
• Educate members, brokers, or groups on membership and billing processes, administrative rules, and portal usage, including contract or policy interpretation.
• Contact clients or state agencies to resolve high volumes of electronic feed and/or web entry issues identified through internal reporting.
• Analyze enrollment status, apply contract provisions for each enrollment scenario, make changes to records, and research and resolve enrollment system rejections.
• Ensure identification cards are generated in a timely manner.
• Respond in a timely manner to incoming/outgoing member, broker, and internal department phone calls.
• Ensure compliance with federal and state regulations.
• Other duties as assigned.

What you will bring

• High School diploma or GED (Required)
• Two (2) years of recent accounting/finance/bookkeeping experience or an Associate’s Degree in accounting/finance/bookkeeping (Required)
• One (1) year prior experience as Membership Analyst I or in a related role with reconciliation experience (Required)

Preferred qualifications

• Health or insurance industry experience
• Associate’s or Bachelor’s degree in accounting/finance

Compensation & Benefits

Salary range

• National Salary Range: $41,500.00 - $62,300.00
• National Plus Salary Range: $47,400.00 - $71,100.00
• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

Benefits (total rewards)

• Medical, vision, and dental coverage with low employee premiums
• Voluntary benefit offerings, including pet insurance
• Life and disability insurance
• Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service
• Wellness incentives, including mental well-being resources for you and your dependents (counseling services, stress management programs, and mindfulness programs)
• Generous paid time off
• Tuition assistance for undergraduate and graduate degrees
• Employee recognition program

Location

• Telecommuter
• Pacific/Mountain/Central Time Zones ONLY working between the hours of 7am to 5pm PT hours
• The employer is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin