Membership Specialist II

Workforce Classification: Telecommuter Join Our Team: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: . The Membership Specialist II will perform moderate to complex reconciliation analysis and audit activities for Individual or Group accounts receivable by using reconciliation databases, receipts, electronic file reconciliation and application of basic accounting principles with minimal supervision. Will resolve a variety of enrollment, reconciliation and billing issues of moderate to complex difficulty and participate in coaching internal and external customers concerning contractual guidelines. Performance drives management of financial risk for the company and customer satisfaction for the members. Pacific/Mountain/Central Time Zones ONLY working between the hours of 7am to 5pm PT hours What you will do: Responsible for identifying, resolving and documenting complex reconciliation discrepancies independently, processing refunds, request transfers of premiums, reinstatements, and insufficient fund issues, processing new enrollment and/or eligibility changes as needed and maintaining accurate and comprehensive notes. Validate appropriate accounts receivable by conducting detailed reconciliation and audit of group or individual premiums and membership of moderate to complex difficulty. Utilize various tools/ appropriate system reports, such as in Access or Excel to aid in updating eligibility, enrollment and/or reconciliation of accounts. Must meet or exceed department metrics: production and quality standards and remain current on company/departmental policies and procedures. Create written correspondence letters using the appropriate system regarding billing and enrollment issues. Research, investigate and resolve complex account discrepancies, premium rate, bill flag suspension and/or corrections and billing issues, reproduce and create customized or manual bills as needed or requested by customer, and ensure timely and accurate maintenance and reporting of inventories. Partner with internal /external partners and members to review and resolve issues; may include Web portal usage and contract interpretation. Conduct complex electronic file accounts receivable and enrollment reconciliation. Educate members, brokers, or groups on membership and billing processes, administrative rules to include portal usage and contract or policy interpretation. Contact clients or state agencies to resolve high volumes of electronic feed and/or web entry issues identified via internal reporting Analyze enrollment status and apply contract provisions for each enrollment scenario, make changes to records, and research and resolve enrollment system rejections. Validate Identification Cards are generated in a timely manner. Respond in a timely manner to all incoming/outgoing member/broker/internal department phone calls. Ensure compliance with federal and state regulations. Other duties as assigned What you will bring: High School diploma or GED. (Required) Two (2) years of recent accounting/finance/bookkeeping experience or an Associate’s Degree in accounting/finance/bookkeeping. (Required) One (1) year prior experience as Membership Analyst I or in a Premera position with reconciliation experience. (Required) Health or insurance industry experience. (Preferred) Associates or Bachelor’s degree in accounting/finance. (Preferred) What you will gain: Build expertise in complex billing, enrollment, and account reconciliation. Strengthen analytical and problem-solving skills through detailed audits. Gain experience using Excel, Access, and reconciliation tools. Develop customer communication and issue-resolution skills. Expand knowledge of healthcare regulations, contracts, and membership processes. Physical Requirements: The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone. Premera total rewards Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including: Medical, vision, and dental coverage with low employee premiums. Voluntary benefit offerings, including pet insurance for paw parents. Life and disability insurance. Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service. Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few. Generous paid time off to reenergize. Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. Employee recognition program to celebrate anniversaries, team accomplishments, and more. For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement. Commuter perks make your trip to work less impactful on the environment and your wallet. Free convenient on-site parking. Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable. Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus. Equal employment opportunity/affirmative action: Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at or via phone at . Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin. The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally target up to and around the midpoint of the range. National Salary Range: $41,500.00 - $62,300.00 National Plus Salary Range: $47,400.00 - $71,100.00 *National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska. We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions. #J-18808-Ljbffr Premera Blue Cross