PacificSource Health Plans

  • Group Processing Specialist

    Job Location US-OR-Springfield
    Job ID
    2018-311
    Type
    Regular Full-Time
    Hiring Pay Range
    $16.00 - $17.00
    # of Openings
    2
    Status
    Non-Exempt
  • Overview

    Process new standard small groups, renewals, and change requests, by entering data in multiple system applications. Generate plan materials and ID cards, meeting entry timelines and accuracy requirements. Ensure compliance with policies, procedures, and applicable laws and regulations.

    Responsibilities

    Essential Responsibilities:

    1. Review and prepare new group materials, group change requests, new group member applications, and renewal changes, for imaging in OnBase application.
    2. Coordinate and confirm benefits and eligibility variations on groups as required. Coordinate with staff to analyze and create new products or plan materials, as needed.
    3. Review group master applications, forms, proposal requests, and correspondence. Follow up with sales staff for missing information.

    4. Analyze new group structure, billing, and reporting requirements. Enter group data into Facets and PSE.

    5. Validate product codes, financial codes, and other related codes for groups and subgroups. Determine if new product is needed to support rating and coordinate with the Facets Business Support Department as needed.

    6. Create and distribute plan materials in accordance with current workflow processes.

    7. Process all group demographic changes.

    8. Generate census and cross-reference member information on master application with final proposal census.

    9. Upload final premium rates based on actual enrollment for new groups, or rates calculated at renewal.

    10. Track group processing status in PSE and enter group notes in Facets.

    11. Verify appointed agent/producer and enter data in Facets.

    12. Develop and update procedures and job aids as needed.

    Supporting Responsibilities:

    1. Meet department and company performance and attendance expectations.
    2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    3. Attend team and department meetings as scheduled.
    4. Perform other duties as assigned.

    Qualifications

    Work Experience: Minimum one year related experience in the health care industry desired. Strong keyboarding and Excel experience required.

     

    Education, Certificates, Licenses: Requires high school diploma or equivalent. Prefer Associate’s Degree in business or healthcare, or equivalent work experience.

     

    Knowledge:  Ability to understand and interpret state and federal insurance laws. Remain current on PacificSource procedures, policies, products, and contracts. Excellent verbal, telephone and written communication skills.

     

    Competencies

    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 less than 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 indentity or age.

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