Membership Services Coordinator

Third-Party Administration offering a stimulating and challenging work environment and long-term growth for a Membership Services Coordinator. THIS IS A DIRECT HIRE POSITION THAT STARTS IN November 2008 AT THE EARLIEST

Duties

Responds to incoming telephone calls from client participants and providers.  The Department will have four representatives on its team.  Each representative will be required to answer approximately 100-125 calls per day.

Determines, maintains and terminates member and/or dependent eligibility for health care benefits.

Enters employer contribution reports into the computer and balances to bank statements.  Communicates with employers on various issues including discrepancies in their reports and late charges.  Prepares various reports relating to employer contributions.

Positively respond to incoming calls from members and providers to include:

a)  explaining group benefits

b)  assisting with claims eligibility issues

c)  claims statusing

d)  assisting the callers with their questions or concerns and providing problem resolution

Employee will be responsible to make adjustments on claims, research questions, and problems, and provide the best solutions available.  When necessary, representative will pull hard copy claims from batches.  If during a slow period, alternating with co-workers to make sure the phones are always covered.

Difficult claims will be transferred to supervisor for handling.

Employee will be expected to handle each call professionally and to the best of his/her ability.  Call transferring is expected to be minimal, and a call will be transferred only if a) the caller is requesting assistance for an area the employee is not trained in, i.e. Pension, Vacation, or b) requires the assistance of a supervisor.

Employee may occasionally make outgoing calls to members and providers.

In the event of phone outages, or slow days, employee may be asked to perform other job duties.  This may include alpha sorting, organizing, claim paying, or other special projects.

It is the responsibility of the Membership Services Coordinator to make sure there is adequate phone coverage with coworkers if they are leaving their desk for any reason.

Employee must be able to have knowledge of and handle multiple group benefits.

Know the plan rules for eligibility as outlined in the SPD for each fund.

Use month end reports to determine eligibility, reinstatement and termination of health care coverage.

Work with Data Entry department to ensure that reported work hours are properly recorded and computed.

Prepares and mails enrollment packages and ID cards to all newly eligible members.

Collects completed enrollment forms and adds all members and their eligible dependents to the Company computer system and any/all outside carrier systems.

Requests and evaluates legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules.

Reviews and Mails monthly status reports and self payment notices to all members.

Collects and enters all self payments and balances deposits twice weekly.

Determine qualifying events and notify member/dependent of COBRA rights.

Maintains all COBRA records.

Identifies and reports to programming department system errors in work hour computations.

Responsible for class code and coverage changes during disability, retirement, death of member & when dependents reach maximum age for coverage.

Works with pension department to arrange for Health & Welfare deduction from pension check for retired member and widows.

Assists members and their dependents with all issues regarding eligibility for benefits.  Explain eligibility rules to members.

Opens all mail relating to employer contribution reports.

Date stamps all material as required.

Prepares bank deposits.

Enters contribution forms in the computer and balances to bank deposits.

Compares data entered with source documents.

Responsible for discrepancy notices.

Responsible for liquidated damages letters.

Prepares contribution reception report.

Responsible for reminder letters.

Prepares various reports for trustee meetings.

Makes copies as required.

Files forms and letters.

Must be flexible and willing to pitch in and work together as a team member.

 

 

QUALIFICATIONS :CANDIDATES THAT DO NOT MEET MANDATORY REQUIREMENTS WILL NOT BE CONSIDERED. 

2 YEARS MINIMUM EXPERIENCE WITH A TPA Employee Benefits position or similar.

Background in medical claims processing, knowledge of medical terminology, will understand reasons for denials and pended claims. 

Effective communication skills are essential.  Individual should enjoy and be able to work in a busy and sometimes noisy pressured environment. 

Ability to apply concepts of basic addition, subtraction, multiplication and division.

Representative must be analytical.  Representative must be able to deal with people in stressful situations.  Good communication skills and keen observation.  Careful attention to what a caller is asking for and then using good judgment.  Ability to apply common sense to carry out detailed written or oral instructions.  Ability to deduce if a balance due is the responsibility of the member or if the plan has yet to consider the charges.

PHYSICAL DEMANDS Occasional lifting of paperwork and batches of claims. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT  Noisy, pressured, stressful