Enrollment Resolution Examiner I

About the role

The Enrollment Resolution Examiner resolves complex enrollment and billing reconciliation issues between the Health Plan and external customers including State and Federal Government Agencies, working across multiple Enrollment operational areas under management direction and in accordance with Health Plan, State and Federal guidelines.

Responsibilities

• Reconcile regulatory and Health Plan Enrollment data through audit and review using internal and external guidelines/regulations/policies and procedures.
• Ensure member and/or group documentation and transactional updates are completed to reconcile account discrepancies.
• Receive, review and update discrepancies from internal departments and external customers relating to Membership subscriber/member/group files.
• Investigate, work, analyze, track and monitor operational issues identified during financial balancing adjustment of funds.
• Participate in process and technology improvement efforts to identify and remove barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction.
• Prepare regular and periodic reports for review and assurance of following processing guidance, including operations reporting of all transactions.
• Initiate necessary requests to other operational areas to resolve identified problems or recommendations for process improvement.
• Communicate with internal and external customers, provide supporting documentation, and make recommendations for procedure changes based on analysis.
• Demonstrate high standards of integrity supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintain high regard for member privacy in accordance with corporate privacy policies and procedures.
• Be proficient in one line of business and able to process inventory from other lines of business as requested.
• Level II additional responsibilities: mentor and collaborate with team members, serve as a role model, support other team members, act as a subject matter expert in one line of business and proficient in several inventory areas in other lines, understand cross‑functional enrollment processes, support implementation of new processes and procedures (including creation of test cases, testing, end‑user testing, documentation, procedure establishment), represent Enrollment Resolution on corporate projects and cross‑functional work groups, providing advice and counsel to project teams and leadership.

Requirements

All levels: Conduct financial analyses and recommendations, or related work experience and proven ability to exercise the position’s requirements and responsibilities.

• Three (3) years’ experience with financial data or Health Insurance Enrollment experience; or an associate degree in finance, accounting, or similar discipline.
• Ability to establish constructive relationships with all levels of internal and external organization.
• Prioritize assignments and work accurately and independently within established time frames.
• Flexible and able to adjust to rapidly changing priorities.
• Solid communication skills – both verbal and written.
• Proven organizational, analytical, and time management skills.
• Computer proficiency, including experience in Microsoft Office Suite.
• Strong attention to detail and accuracy.
• Physical requirements: ability to work in a traditional office environment under fluorescent lighting, arrive on time, meet minimum performance metrics, communicate orally, function while sitting at a desk viewing a computer and using keyboard/mouse for 3+ hours, travel across the enterprise, work in a home office for continuous periods for business continuity.

Qualifications

Level II preferred qualifications: minimum of five (5) years health insurance operations experience; ability to represent the department independently as a subject matter expert; in‑depth regulatory and Enrollment process knowledge in one line of business and working knowledge in an additional line of business; proven ability to support and train peers.

Skills

Skills implied from requirements: financial data analysis, enrollment/billing reconciliation, regulatory knowledge, reporting, process improvement, communication, organization, analytical thinking, time management, Microsoft Office proficiency, attention to detail, relationship building, prioritization, flexibility, mentoring (Level II).

Benefits

• Participation in group health and/or dental insurance
• Retirement plan
• Wellness program
• Paid time away from work
• Paid holidays

Pay

Level I: Grade N5 – Minimum $21.20 – Maximum $33.03 per hour.
Level II: Grade N6 – Minimum $22.50 – Maximum $35.00 per hour.