Membership Representative ll

About the role

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.
• Maintains enrollment database.
• 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.
• Determines eligibility and applies contract language for each case assigned.
• 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 error output resolution for electronic eligibility and processes error discrepancy lists.
• Maintains and reconciles premium bill, self-bill and individual billed accounts.
• Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.
• 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.
• Maintains and reconciles premium bill, self-bill and individual billed accounts.
• Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.
• 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.

Requirements

• Requires H.S. diploma or GED and a minimum of 1 year relevant healthcare customer servicing experience which includes a minimum of 1 year membership experience with the company; or any combination of education and experience which would provide an equivalent background.

Qualifications

• Must be able to successfully perform all the duties of the Membership Rep I.

Skills

• Strong verbal and written communication skills, both with virtual and in-person interactions.
• Detail-oriented, critical thinker, and a problem-solver.
• Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• The ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401(k) contribution.

Pay

Location-specific salary range for this specific position is $17.54 to $26.30. Location(s): Norfolk, VA and Richmond, VA.

Schedule

This position will work an 8-hour shift from 8:00 am - 5:00 pm (EDT), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Equal Employment Opportunity

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.