Individual Membership Representative II
PacificSource

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Join PacificSource and help our members access quality, affordable care!

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.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Provide professional, high quality customer service to individual applicants, members, producers, and internal customers, pertaining to our Individual line of business. Responsible for incoming and outbound calls and processing time sensitive documents including but not limited to processing enrollment transactions, policy changes, terminations and reconciliation of accounts. Ability to gain knowledge of the requirements/regulations for the Federal and State Based Exchanges.

Essential Responsibilities:

• Process individual enrollments, changes, terminations, APTC status updates, for subscribers and dependents. This will be maintained through Enrollment Management System (EMS), Facets and through monthly audits including but not limited to the FFM Pre-Audit file.
• Answer incoming calls, documenting each call in Facets.
• Audit and review new policies and all pertinent documents using systems including PacificSource Enterprise (PSE), OnBase, Enrollment Management System (EMS) and SEED.
• Process Discretionary Billing Items, refunds, cash transfers, and write offs as needed following Centers for Medicare & Medicaid Services (CMS) regulations.
• Monitor and process appeals and escalated cases from the Federal Exchange via HICS (Health Insurance Casework System).
• Monitor e-mail queue and provide e-mail support to agents, members and internal customers regarding eligibility, status of applications and other various requests.
• Generate correspondence following company and Exchange guidelines, ensuring consistency and accuracy.
• Maintain accuracy standards as required to meet department and PacificSource PRISM measures. Complete all daily, weekly, bi-monthly and monthly reports for active and terminated members.
• Electronically upload images into imaging system. Prepare documents for manual imaging if needed.
• Maintain data alignment with the Federal and State Based Exchanges. Working monthly audits in addition to any other audits that are presented.
• Set up and maintain transactions including Electronic payments, Electronic Fund Transfer (EFT) records, Recurring Payments, Insufficient funds in system. Audit file of electronic funds transfer transactions.
• Conduct testing and provide feedback for system upgrades/enhancements, special projects and process improvements.
• Provide back up and mentoring to Individual Membership Rep 1's and maintain up to date knowledge on the direct line of business.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations. Review, update and maintain policy and procedures as needed.
• Attend team, department, company meetings, and mentor lessons as scheduled.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of two years prior customer service, medical insurance or other healthcare related experience required. PacificSource Individual Membership Rep 1, insurance or healthcare experience preferred.

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

Knowledge: Must possess excellent communication skills both verbal and written, intermediate excel knowledge, strong keyboarding skills, problem solving skills and being able to multi-task. Ability to effectively articulate rates, contract provisions and processes to internal and external customers. Ability to adhere to company and department policies and meet expectations for service, accuracy and efficiency. Also the ability to define and prioritize problems and manage workload without direct supervision.

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

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

Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• 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-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

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.

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