Responsible for maintaining the TPA industry integrity of First Choice Health relating to Enrollment and COBRA Administration by providing exemplary services according to department standards.
- Partner with Account Executives, Business Analysts and EDI Services for Client implementation and renewal to ensure the system is properly set up to accept member enrollment.
- Process Eligibility Enrollments and Terminations efficiently and timely within department standards, via several methods including EDI.
- Serve as a point of contact for all assigned Clients as it relates to enrollment.
- Manage workloads independently, with little supervision.
- Pull and process eligibility reports and deliver to necessary Clients within required deadlines.
- Issue notices relating to eligibility according to department standards.
- Maintain and follow department and client specific Policies and Procedures.
- Perform other enrollment related duties as assigned.
- Process all aspects of COBRA Administration for an assigned book of TPA Clients.
- Work closely with Compliance to keep a working knowledge of COBRA regulations.
- Maintain COBRA eligibility accordingly.
- Serve as a point of contact for COBRA participants via telephone and/or email.
- Issue all COBRA Notices according to federal guidelines and department standards.
- Handle every aspect of premium billing, including invoicing, processing incoming payments, and requesting refunds when necessary.
- Follow department Policy and Procedures.
- Perform other COBRA related duties as assigned.
- Work closely with EDI Services related to incoming and outgoing EDI files, including the testing of any new or changing files.
- Prepare and file all related outgoing mail according to departmental standards.
- Import and index all documents coming into and going out of the department according to department standards.
- Track daily productivity based on departmental guidelines.
- Serve as a backup to other Member Services Representatives when necessary.
- Perform other duties as assigned.
- High School Diploma/GED with a strong background in the healthcare industry, preferred.
- Experience in COBRA administration, preferred.
- 3 to 5 years billing background, preferred.
- Experience in eligibility/enrollment, preferred.
- Strong analytical, organizational, communication, and interpersonal skills, required.
- Ability to work independently and as a team, required.
- Strong customer service background, working with both internal and external customers.
- Prior experience in process improvement methodology.
- Prior experience in performing multiple duties, required.
- Intermediate software application experience with Google Workspace, MS Word and Excel.
- Finger and hand dexterity.
- Ability to see and hear within normal ranges.
- Ability to sit for long periods of time.
- Ability to ambulate short distances.
Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.Click here to learn more about our competitive benefit package.
How to Apply
Please submit your resume to [email protected].
Additional information about our company may be found on our website www.fchn.com