Enrollment Resolution Examiner I

About the role

The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas.

Responsibilities

• Reconcile regulatory and Health Plan Enrollment data through audit and review, utilizing 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 the 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 the 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 completed.
• Demonstrate high standards of integrity, support the Lifetime Healthcare Companies’ mission and values, adhere to the Corporate Code of Conduct, and uphold 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: Mentor and collaborate with team members on tools, best practices, and serve as a role model.
• Level II: Support other team members within primary line of business by responding to questions, demonstrating key tasks and reviewing work.
• Level II: Act as subject matter expert in one line of business and proficient in several inventory areas in other lines of business.
• Level II: Have in‑depth understanding of cross‑functional enrollment processes to research and resolve discrepancies or inquiries.
• Level II: Support implementation of new processes and procedures related to Resolution Examiner inventory work (create test cases, testing, end‑user testing, create documents, establish procedures).
• Level II: Represent Enrollment Resolution on corporate projects and cross‑functional work groups, providing advice and counsel to project teams and leadership on requirements.

Qualifications

• Three (3) years’ experience with financial data or Health