Individual Membership Representative I

PacificSource•Springfield, OR

About The Position

Looking for a way to make an impact and help people? 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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity 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 applications, policy changes, terminations and reconciliation of accounts.

Requirements

Minimum of one year prior customer service, medical insurance or other healthcare related experience required.
High School diploma or equivalent required.
Must possess excellent communication skills both verbal and written, basic 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.

Nice To Haves

Insurance or healthcare experience preferred.

Responsibilities

Process individual enrollments, changes, and terminations for subscribers and dependents via email, fax, mail, spreadsheet, 834 files, Online Enrollment System (OES), InTouch, and other formats.
Use applicable policies and regulations to determine eligibility for enrollment.
Obtain missing information by contacting members and producers.
Answer incoming calls, documenting each call in Facets.
Audit and review new policies and all pertinent documents using systems including PacificSource Enterprise (PSE), OnBase and Enrollment Management System (EMS).
Process Discretionary Billing Items, refunds, cash transfers, and write offs as needed.
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 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.
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.
Meet department and company performance and attendance expectations.
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.
Review, update and maintain policy and procedures as needed.
Perform other duties as assigned.