Membership Representative I

Membership Representative I

Requirements

• HS diploma or GED and related experience; or any combination of education and experience which would provide an equivalent background.

Responsibilities

• Responds to incoming calls and may initiate outgoing calls, providing customer service to plan members, providers and employer groups by answering benefit questions, resolving issues and educating callers.
• Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections; addresses a variety of enrollment questions and/or concerns received by phone or mail.
• May be responsible for billing and delinquency processes for assigned groups.
• Ensures accuracy and timeliness of the membership and billing function.
• Responds to inquiries concerning enrollment processes.
• Maintains enrollment database.
• May order identification cards.
• Determines eligibility and applies contract language for each case assigned.
• Performs error output resolution for electronic eligibility and processes error discrepancy list.
• Bills, collects premiums and reconciles payments.
• Maintains and reconciles premium bill, self-bill and individual billed accounts.
• Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.
• Screens all forms and data for all paperwork received from Sales and/or Underwriting for new group and/or group re-classing benefits.
• Makes request to Underwriting, Sales or Brokers for missing information and/or forms needed for new group or re-class of existing group.
• May be responsible for loading rates to new groups and renewal/re-class groups within the appropriate system.
• Screens group for benefits to determine if existing or new, recognizing when benefits are not standard and handling as appropriate.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Performs basic job functions with help from co-workers, specialists and managers on non-basic issues.

Preferred Qualifications

No preferred qualifications provided.