Membership Administrator III
Cambia Health Solutions

Job Info

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Membership Administrator III

Remote within WA, ID, OR, and UT

Primary Job Purpose:

The Membership Administrator establishes and maintains eligibility, bills premium, reconciles cash, pursues aged accounts and provides eligibility and billing related customer service for Individual, Group, Government Programs, Cobra and Flexible Spending business. Additionally, the Membership Administrator applies many of the procedures and services performed as a Membership Administrator I to complex and specialized accounts, requiring more in-depth knowledge.

Normally to be proficient in the competencies listed below:

The Membership Administrator II would have a High School diploma or GED and one year experience as Membership Administrator I performing all duties at the Core or higher performance level or an equivalent combination of education and job-related work experience.

Responsibilities:

• Perform accurately and timely all eligibility and reconciliation tasks and adhere to established procedures for working large, complex or specialized accounts.
  
• Assist less experienced staff with questions and/or difficult issues or accounts as needed.
  
• Assist Membership Administrator III and Member Services Lead as appropriate.
  
• Conduct professional presentations and training for a variety of customers including employer groups and agents.
  
• Process Individual, and/or, small, large or specialized group enrollment applications. Calculate appropriate waiting-period credit, eligibility data, effective date, and enter benefits, bank draft identification information, name, social security number, address, family members and primary care physician information with network coding, which is consistent with the employer/individual contract.
  
• Review, maintain and enter changes on individual and/or group accounts which may include change of effective date(s) for insured coverage or members, addition or deletion of insured or members from coverage, etc. Sources for this information are applications, invoices, reports or web based data.
  
• Place, receive and track calls to obtain information required to complete application processing such as calling an employer or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan.
  
• Provide customer service to internal and external customers, including Regulatory inquiries by supplying information through written correspondence and responding to telephone inquiries. Make any necessary corrections or adjustments.
  
• Perform all eligibility and reconciliation tasks accurately and timely for assigned business segment, adhering to established procedures including identification of discrepancies between payment and amount invoiced.
  
• Generate group or individual billings. Review billings and ensure accuracy before distributing.
  
• Order member cards and audit these against the member applications for accuracy correct corporate logos, lines of business co-pay, PCP, and any member card comments.
  
• Appropriately apply corporate underwriting and governmental guidelines and policies in eligibility processing.
  
• Ensure cash is processed through daily reconciliation to achieve established cash turnaround standards.
  
• Identify and prioritize work in order to meet deadlines.
  
• Maintain manuals to ensure policies and procedures are current.
  
• Monitor, pursue and report on aged accounts to ensure amounts are accurate and cleared in time to meet goal of achieving corporate standards.
  
• For Government Programs related jobs, maintain updated knowledge of State and Federal regulations.
  
• Incorporate and apply changes made to Membership Accounting, Underwriting or State and Federal policies and procedures to ensure current requirements are met.
  
• Ability to meet established departmental performance expectations.
  
• Ensure member confidentiality in all aspects of eligibility and billing processes.
  
• Comply with MTM, Consortium or Governmental quality, timeliness and other standards as they relate to membership activities and responses to inquiries to meet BlueCross and BlueShield Association or CMS standards and corporate goals.
  
• Coordinate transfer, receipt and processing of electronic data as applicable with various outside entities including CMS, employer groups, agents and vendors.
  
• Develop test cases and assist with user acceptance and system integration testing.
  
• Work overtime and on weekends, as necessary.
  
• Perform various clerical tasks.
  
• Backup other staff members by providing phone coverage and assisting with mail, filing and other special projects.
  
• Attend and participate in training and staff meetings.
  

Minimum Requirements:

• 40 wpm with 95% accuracy typing skills.
  
• 10-key by touch (8500 keystrokes per hour with 95% accuracy preferred).
  
• Demonstrated strong math skills (mathematical calculations and concepts) and judgment to implement effective problem solving.
  
• PC experience - Word, Excel and Outlook - or comparable software - and ability to learn and use complex systems.
  
• Ability to organize and prioritize work.
  
• Must be detail-oriented and self-motivated.
  
• Must be dependable and maintain attendance at or above departmental standards.
  
• Must be able to exercise judgment, initiative and discretion in confidential, mature and sensitive manner.
  
• Must be able to communicate effectively both orally and in writing.
  
• Must be able to establish effective working relationships with staff and customers.
  

Work Environment:

• Repetitive actions of utilizing a PC keyboard and mouse.
  
• Sitting at workstation for extended periods of time.
  

The base pay annual salary range for this job is $15.82 - $29.68/hour,depending on candidate's geographic location.

The annual incentive payment target for this position is 5%.

At Regence, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we do not hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights include:

• Medical, dental, and vision coverage for employees and their eligible family members
  
• Annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• Paid time off and company holidays
  
• Up to a 6% company match on employee 401k contributions (no vesting period)
  
• Up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• One-time furniture and equipment allowance for employees working from home
  
• Up to $225 in Amazon gift cards for participating in various well-being activities
  

For a complete list see our External Total Rewards at https://www.cambiahealth.com/careers/total-rewards

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

Information about how Cambia Heath Solutions collects, uses, and discloses information is available in our Privacy Policy.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• paid time off and company holidays
  
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• one-time furniture and equipment allowance for employees working from home
  
• up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page.
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

This job has expired.