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.
Review group master applications, forms, proposal requests, and correspondence. Follow up with sales staff for missing information.
Analyze new group structure, billing, and reporting requirements. Enter group data into Facets and PSE.
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.
Create and distribute plan materials in accordance with current workflow processes.
Process all group demographic changes.
Generate census and cross-reference member information on master application with final proposal census.
Upload final premium rates based on actual enrollment for new groups, or rates calculated at renewal.
Track group processing status in PSE and enter group notes in Facets.
Verify appointed agent/producer and enter data in Facets.
Develop and update procedures and job aids as needed.
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.
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.