Membership Administrator I Or II

Cambia Health Pocatello , ID 83205

Posted 2 months ago

Primary Job Purpose

Remote within: OR, WA, or ID

The Membership Administrator I establishes and maintains eligibility, bills premium, reconciles cash, pursues aged accounts and provides eligibility and billing related customer service for Individual, Group, Government Programs, Cobra and Flexible Spending business.

General Functions and Outcomes

  • Process Individual, and/or small, large or specialized group enrollment applications. Calculate appropriate waiting-period credit, eligibility data, effective date, and enter benefits, bank draft identification information, name, social security number, address, family members and primary care physician information with network coding, which is consistent with the employer/individual contract.

  • Review, maintain and enter changes on individual and/or group accounts which may include change of effective date(s) for insured coverage or members, addition or deletion of insured or members from coverage, etc.

  • Place, receive and track calls to obtain information required to complete application processing such as calling an employer or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan.

  • Provide customer service to internal and external customers by supplying information through written correspondence and responding to telephone inquiries. Make any necessary corrections or adjustments.

  • Perform all eligibility and reconciliation tasks accurately and timely for assigned business segment, adhering to established procedures including identification of discrepancies between payment and amount invoiced.

  • Generate group or individual billings. Review billings and ensure accuracy before distributing.

  • Order member cards and audit these against the member applications for accuracy, correct corporate logos, lines of business co-pay, PCP, and any member card comments.

  • Appropriately apply corporate underwriting and governmental guidelines and policies in eligibility processing.

  • Ensure cash is processed through daily reconciliation to achieve established cash turnaround standards.

  • Identify and prioritize work in order to meet deadlines.

  • Monitor, pursue and report on aged accounts to ensure amounts are accurate and cleared in time to meet goal of achieving corporate standards.

  • For Government Programs related jobs, gain working knowledge of State and Federal regulations.

  • Incorporate and apply changes made to Membership Accounting, Underwriting or State and Federal policies and procedures to ensure current requirements are met.

  • Meet established departmental performance expectations.

  • Ensure member confidentiality in all aspects of eligibility and billing processes.

  • Comply with MTM, Consortium or Governmental quality, timeliness and other standards as they relate to membership activities and responses to inquiries to meet BlueCross and BlueShield Association or CMS standards and corporate goals.

  • Coordinate transfer and receipt of electronic data as applicable with various outside entities including CMS, employer groups, agents and vendors.

  • Assist with user acceptance and system integration testing.

  • Work overtime and on weekends, as necessary.

  • Perform various clerical tasks.

  • Backup other staff members by providing phone coverage and assisting with mail, filing and other special projects.

  • Attend and participate in training and staff meetings.

Minimum Requirements

  • 30 wpm with 95% accuracy typing skills.

  • 10-key by touch (8500 keystrokes per hour with 95% accuracy preferred).

  • PC experience - Word, Excel and Outlook - or comparable software - and ability to learn and use complex systems.

  • Strong math skills (mathematical calculations and concepts), judgment and other resources to implement effective problem solving.

  • Ability to organize and prioritize work.

  • Must be detail-oriented and self-motivated.

  • Must be dependable and maintain attendance at or above departmental standards.

  • Must be able to exercise judgment, initiative and discretion in confidential, mature and sensitive manner.

  • Must be able to communicate effectively both orally and in writing.

  • Must be able to establish effective working relationships with staff and customers

Normally to be proficient in the competencies listed above

The Membership Administrator I would have a High School diploma or GED and one year accounts receivable or customer billing experience or an equivalent combination of education and job-related work experience.

Work Environment

  • Repetitive actions of utilizing a PC keyboard and mouse.

  • Sitting at workstation for extended periods of time.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.


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Membership Administrator I Or II

Cambia Health