Healthcare Collections and Reconciliation
Enclipse Corp. - Rockville, MD

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Title: Group Representative
Purpose of Job

Administers financial terms negotiated under customized and standardized group and individual contracts.

In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Service Quality Credo, as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.

Duties and Responsibilities

Services customized and standardized groups with multiple product lines and benefits structures. Performs reconciliations utilizing various software systems. Determines if employer's monthly premium payment is accurate based on the addition and termination of covered employees.

Researches and resolves eligibility and rate discrepancies. Works closely with the HR benefits staff of employer groups, web based applications, and Consolidated Service System to ensure that there is contractual compliance with the financial terms. Requests additional premium from employer to cover employees added to group contract.

Process terminations and reinstatements of groups and individual member accounts as outlined by the credit policy and/or recommends exceptions; may collect and relay information to management regarding customized alternative payment arrangements. Prepares reports detailing the reconciliation of premiums for assigned employers groups.

Coordinates with processor(s) to ensure that clerical work on the account is performed in accordance with the group's requirements. Identifies changes on eligibility reports

Identifies delinquent accounts and initiates the process to have the outstanding balances submitted to the collection agency

Administration of group and individual member contract account balances

Administer payment options for group and individual member contracts (to include credit cards, recurring credit cards)

Processes eligibility to include enrollment, changes to enrollment and member terminations

Interacts with internal departments, internal staff, and external customers to resolve concerns and inquires in support of individual employer group contract administration

Performs other related duties as directed

Minimum Qualifications:
Three years of experience with account reconciliation and detailed analysis utilizing financial systems preferably in an insurance or health care environment. Customer Service, Accounting background, Data Entry, Excel and Access experience

Education and Training:
High school diploma or GED required, Two-year degree in accounting, business administration, or a related discipline preferred.

Proficiency in the use of applicable computer software.

Effective interpersonal and communication skills.

Hours and days: - Mon thru Friday 8 hrs a day

Top skills needed to succeed in this position:

Top daily responsibilities:

Top 3 personality characteristics:

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