Premium Analyst (Manager Care)

Why Join Us

At Novacore, we’re not your average insurance company. We’re a team of driven professionals passionate about redefining the specialty insurance experience for our agents, carrier partners — and for each other. We specialize in tailored solutions for niche industries, powered by advanced analytics, modern technology and a culture of innovation. Backed by strong leadership and strategic growth initiatives, Novacore is poised to scale and lead in the specialty insurance market.

Recognized as a top workplace, Novacore is a place where ambition is supported, growth is continuous and culture matters. From day one, you’ll find mentorship, hands-on learning and clear paths for advancement. You’ll grow your skills, expand your expertise and become even more exceptional — because when you succeed, we all do.

Benefits

• A collaborative, results-driven environment
• Competitive compensation and comprehensive benefits
• Year-round social and community events
• Ongoing mentorship and professional development
• Endless opportunities for upward mobility

Responsibilities

Premium Billing Management

• Oversee and process monthly premium billings for managed care products (HMO, PPO, EPO, CDHP) and self-funded health plan arrangements, ensuring accuracy and timeliness.
• Review and analyze complex premium data, including composite and age-banded rating structures, adjusting for enrollment changes, plan design amendments, carrier rate changes, and mid-year renewals.
• Administer premium remittance to carrier partners and reinsurers, ensuring proper allocation across multiple funding arrangements (fully insured, level-funded, and self-funded).
• Collaborate with internal teams and outsourced partners to ensure premiums are billed accurately based on current enrollment data, benefit plan details, and carrier contract terms.

Enrollment & Eligibility Administration

• Process and validate member enrollment and eligibility data received from employer groups, ensuring accurate subscriber and dependent counts are reflected in monthly billings.
• Manage retroactive enrollment adjustments and retroactive terminations, calculating and applying premium credits or back-billings as appropriate.
• Coordinate with carrier partners to confirm eligibility file transmissions and resolve discrepancies between internal records and carrier enrollment rosters.

Client Communication & Support

• Serve as the primary point of contact for employer groups and brokers regarding premium billing inquiries, enrollment discrepancies, and payment issues specific to managed care products.
• Provide clear, timely, and professional communication regarding billing statements, premium adjustments, payment schedules, and grace period policies in accordance with managed care contract terms.
• Assist clients in understanding billing statements, rate structures, dependent tier categories, and payment schedules across multiple managed care plans offered under their group contracts.

Reconciliation & Reporting

• Perform reconciliation of premium payments against carrier invoices and internal billing records, including matching payments, identifying discrepancies across multiple plan options, and resolving outstanding balances.
• Prepare management reports highlighting billing trends, enrollment fluctuations, payment status, loss ratio indicators, and any potential issues affecting the managed care book of business.
• Issue and manage delinquency notices in accordance with carrier contract requirements and applicable state continuation of coverage (COBRA/state continuation) regulations.
• Track and report on experience refunds, dividend calculations, and carrier settlement reconciliations applicable to experience-rated managed care programs.

Process Improvement & Compliance

• Recommend and implement process improvements to enhance billing accuracy, enrollment data integrity, and client satisfaction across the managed care program portfolio.
• Ensure compliance with all applicable regulatory requirements including ACA mandates, ERISA, HIPAA privacy standards, and state insurance department regulations governing premium billing and group health coverage.
• Assist in internal and external audits, ensuring that all billing records, enrollment files, and carrier remittance documentation are accurately maintained and readily available for review.

Carrier & Network Partner Relations

• Maintain strong working relationships with carrier billing contacts to facilitate timely resolution of premium discrepancies, enrollment file errors, and remittance reconciliation issues.
• Liaise with underwriting, network management, and claims teams to ensure premium rates accurately reflect negotiated network access fees, stop loss attachment points, and any applicable medical management program charges.

Collaboration

• Work closely with underwriting, claims, network management, and policy issuance teams to ensure premiums are billed correctly and reflect current plan designs, negotiated rates, and carrier contract terms.
• Assist in the training and mentorship of junior billing staff, providing guidance on complex managed care billing scenarios including multi-carrier arrangements and tiered network products.

Problem Solving & Issue Resolution

• Investigate and resolve billing discrepancies and client disputes related to premiums, enrollment counts, rate tier classifications, or carrier remittance errors across managed care products.
• Escalate complex issues to management as needed while proposing effective solutions, particularly for situations involving carrier coverage disputes, retroactive rate changes, or lapse and reinstatement scenarios.

Qualifications

• Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field preferred.
• Minimum of 5+ years of experience in premium billing within the health insurance or managed care industry.
• Demonstrated experience with managed care products including HMO, PPO, EPO, and CDHP plans; experience with self-funded and level-funded arrangements strongly preferred.
• Experience working with an MGU, TPA, health plan carrier, or employee benefits brokerage/consulting firm preferred.
• Strong experience with billing systems, benefits administration platforms, and accounting software. Experience with ESL Office, BenAdmin, or similar group health billing systems preferred.
• Strong attention to detail and accuracy in high-volume, multi-plan billing environments.
• Familiarity with managed care concepts including network tiering, utilization management, care coordination, medical management programs, and their impact on premium structures.
• Knowledge of ACA compliance requirements, ERISA, HIPAA, COBRA, and state-specific group health insurance regulations.
• Excellent organizational and time management skills with the ability to manage multiple group accounts, billing cycles, and carrier relationships simultaneously.
• Strong communication skills, both written and verbal, with the ability to explain complex billing and managed care concepts to employer groups, brokers, and internal stakeholders.
• Proficient in Microsoft Office Suite, particularly Excel (including pivot tables and VLOOKUP for enrollment and billing reconciliation); experience with data imports/exports between billing and enrollment systems preferred.
• Ability to work under pressure and meet tight billing deadlines while maintaining accuracy across a multi-carrier, multi-product managed care book of business.