Senior Membership Billing Rep-TPA

Job Title

Medical Mutual employees must submit their applications through MySource.

Note: This is a remote position however, candidates must reside in the Cleveland/Brooklyn, Ohio area.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary

Under limited supervision, provides administrative support in the membership and billing areas. Maintains member health plan records and sends monthly invoices to clients for administration fees associated with their employee benefit plan. Functions as the first point of contact for internal clients, groups and brokers regarding routine to varied and/or complex eligibility and billing inquiries. Serves as a resource to more junior level Representatives and assists management with special projects as needed.

Responsibilities

Processes routine to varied and/or complex member enrollment transactions such as group additions, terminations, renewals, etc.

Prepares routine to varied and/or complex invoices and reports.

Reviews/updates open enrollment changes such as Coordination of Benefits (COB), dependent updates, etc.

Researches and responds to routine to varied and/or more complex eligibility inquiries via fax, postal mail or e-mail regarding eligibility feeds and files, and eligibility issues on vendor websites (i.e dental, RX, vision).

Creates and executes system test plans/scripts, system upgrades, and/or new releases.

Participates frequently in onsite and phone client implementation meetings to provide sales support.

Verifies proper and timely review and approval of enrollment information submitted by customers via the secured website within expected turnaround times.

Verifies proper coordination and documentation of correspondence and distribution into workflow.

Orients, trains and assists more junior level Representatives, and collaborates with other departments on group set ups, providing assistance as needed.

Analyzes deficiencies in processes/procedures and recommends improvements to management and implements with management approval.

Performs other duties as assigned.

Qualifications

Education and Experience:

Bachelors' Degree in Business Administration, Communications or related field preferred, but will consider collective experience, training and education.

3 years' experience as a Membership/Billing Representative or equivalent experience in health insurance membership and/or billing, preferably in a third party administration environment.

Professional Certification(s): Health Care field certification a plus (i.e. medical terminology, certified coder/biller, etc.)

Technical Skills and Knowledge:

Strong knowledge of health insurance products, medical terminology, premium ratings and eligibility administration.

Intermediate to advanced proficiency with Microsoft Office and health insurance operations systems.

Strong math skills.

Ability to interpret documents of varied complexity.

Solid data entry skills.

Benefits

A Great Place to Work:

We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.

Employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.

On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.

Discounts at many places in and around town, just for being a Medical Mutual team member.

The opportunity to earn cash rewards for shopping with our customers.

Business casual attire, including jeans.

Excellent Benefits and Compensation:

Employee bonus program.

401(k) with company match up to 4% and an additional company contribution.

Health Savings Account with a company matching contribution.

Excellent medical, dental, vision, life and disability insurance insurance is what we do best, and we make affordable coverage for our team a priority.

Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.

Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.

After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

Career development programs and classes.

Mentoring and coaching to help you advance in your career.

Tuition reimbursement up to $5,250 per year, the IRS maximum.

Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.