Member Processing Administrator
Word & Brown Companies - Orange, CA

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Quality check, verify eligibility and process for all enrollment materials for participants in the Choice Administrators programs.

Understand company policies and procedures as they apply to Choice Administrators plans.
Follows all established process and procedures to ensure integrity, security and confidentiality of all data.
Receives, process and verifies the accuracy of employee applications, change/renewal request, terminations, and other documents for data entry.
Processes applications/enrollment materials with a high level of accuracy and ascertains appropriate level of eligibility status.
Communicates closely with internal resources to ensure all instructions are accurate and understood.
Identifies and reports all inconsistencies found in the data.
Ability to identify employee and employer documents by using our paper less system Doc-Link, verify and update information contained in Pegasus (mainframe), and process based on guidelines.
Communicate directly with clients via phone or email with confidence and authority as a representative of the department.
Maintain acceptable accuracy rates.
Provide clear and concise pending item requests to obtain missing or incomplete information via phone, fax or email.
Ability to explain all eligibility requirements and procedures to internal and external customer.
Provide clear and concise correspondence in and outside of the department (i.e. denials, confirmations, memos, letters, etc.)
Ability to enter appropriate comments in a clear and concise manner onto Pegasus and/or Doc link.
Ability to assess and forward documents to the appropriate team(s) or departments.
Meet department standards for quality, quantity of work, and service levels.
Adhere to all PHI (Personal Heath Information) guidelines.
Perform the tasks and functions necessary to manager daily work bin.
Provide feedback regarding training needs based on error report(s), interaction with team member(s), or department(s).
Assist with departmental training needs as assigned by leadership team.
Other duties as assigned by the Leadership team.

Experience Requirements:
5+ years of office and/or customer service experience required. At least one year of data entry experience.

Knowledge, Skills & Abilities Required:
Strong communication skills (written, grammatical and verbal) required
Ability to interact and communicate effectively with all levels of employees and customers.
Must have strong attention to detail, strong analytical skills and problem analysis/solving skills to identify trends and improve processes to resolve issues.
Ability to perform comfortably in a fast-paced, deadline-oriented professional work environment.
Excellent customer service and organizational skills.
Able to build/gain commitment and overcome resistance to change.
ability to retain large quantities of information.
Must be able to handle multiple tasks at one time.
Accurately type a minimum of 50 WPM
Proficient with Microsoft Office software (Access, Word, Excel, PowerPoint, Visio, Publisher, SharePoint, Outlook), web based technology.
Must be highly motivated, have ability to take initiative, be accountable, have excellent interpersonal, and service oriented skills.
Knowledge of the healthcare industry a plus.

Word & Brown Companies - 13 months ago - save job - copy to clipboard
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