PacificSource Health Plans

  • Group Membership Representative I

    Job Location US-ID-Boise
    Job ID
    Regular Full-Time
    Hiring Pay Range
    $16.00 to $17.00 per hour
    # of Openings
  • Overview

    Administer commercial fully insured group accounts.  Process enrollment and disenrollment transactions. Provide customer service by phone and e-mail to group administrators, brokers, and members.  Review and post daily payments, and reconcile accounts.  Establish relationships with administrators, attend renewal meetings, and meet with group administrators as authorized.   


    1. Process group enrollment applications, changes, terminations, waivers and continuation forms for subscribers and dependents via billing statements, mail, email, fax, spreadsheet, 834 files, OES, InTouch, and other formats. Use group contract information to determine eligibility for enrollment. Obtain missing information by contacting group administrators.
    2. Log into all states group department phone queues during scheduled shift, documenting all calls and responding to daily emails and voicemails.  Assist members, agents, and group administrators with eligibility, regulations, COBRA & state continuation administration, demographic changes, ID cards, calculations of group premium balances, and rate questions.
    3. Process electronic/lockbox deposits daily.  Prepare manual deposits to be sent to lockbox for processing.  Process manual deposits as needed. Prepare setup, staging, and spreadsheet with daily totals to Finance.
    4. Reconcile group balances as needed and prior to renewal. Process Claims Pay Holds, Rating Overrides, Discretionary Billing Items, refunds, cash transfers, and write offs as needed.
    5. Maintain State or Federal Exchange group accounts.
    6. Contact groups scheduled to term due to non-payment. Process reinstatements if required.
    7. Monitor the representative and department RightFax and email queues and distribute information to the appropriate party for processing.
    8. Maintain accuracy standards as required to meet department and PacificSource PRISM measures.
    9. Complete all daily, weekly, bi-monthly and monthly reports.
    10. Electronically upload images into imaging system. Prepare documents for manual imaging if needed.
    11. Meet with new and existing group administrators as requested by marketing sales, agents, and group administrators. Initiate visits to promote customer training and service.


    Supporting Responsibilities:

    1. Process Individual credit card payments in when taking calls from the Individual phone queues.
    2. Log into all states individual billing phone queues to provide backup as needed, documenting all calls.
    3. Provide assistance to individual members and process reinstatements if needed.
    4. Meet department and company performance and attendance expectations.
    5. Attend team, department, company meetings, and mentor lessons as scheduled.
    6. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    7. Knowledge of Health Savings Account contracts.
    8. Perform other duties as assigned.


    Work Experience: Minimum of one year prior Accounting/Accounts Receivable experience with strong keyboarding and 10-key experience required. Basic Excel skills required. Prior Customer Service experience required.


    Education, Certificates, Licenses: High School diploma or equivalent required.


    Knowledge:  Ability to gain understanding of group terminations and/or process and alternated funding arrangement contracts.  Basic math skills required, including percentages, ratios, graphing and spreadsheet skills required.  Excellent customer service skills needed with verbal, telephone and written communication skills.  Requires problem solving skills and being able to multi-task.  Also the ability to define and prioritize problems and manage workload without direct supervision.   



    Our Values

    • Building Customer Loyalty
    • Building Strategic Work Relationships
    • Continuous Improvement 
    • Adaptability
    • Building Trust
    • Work Standards
    • Contributing to Team Success
    • Planning and Organizing



    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers' experience.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our many communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence. 


    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.


    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.


    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.


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