The Membership Processor is responsible for assisting in ensuring enrollment functions are processed accurately and timely. These enrollment functions include enrollment additions, changes, reinstatements and billing. Additional duties include accurate and timely distribution of SHOP group and Individual ID cards, Certificate of Coverage, Individual Policies, Certificate of Creditable Coverage, and other fulfillment information.
Providing excellent customer service in contact with internal and external customers is a major responsibility of the incumbent including the necessary research in AMISYS to respond to customer inquiries internal and external. This incumbent is subject to all Enterprise and divisional standards for quality and performance.
Nature & Scope
The environment is one of teamwork, in which all team members’ work together in order to provide excellent service through timely and accurate enrollment processing, fulfillment and distribution of policy and benefit materials, and customer service. Work volume is consistently heavy with peak times during open enrollment periods and traditional high volume for new group sales.
The Membership Process receives SHOP group enrollment applications on a daily basis for system entry. Individual policies will be received for manual entry should system issues occur within the electronic enrollment process. The incumbent also works through daily reports from the automated process for both on and off exchange business. ID cards are verified and mailed with benefit materials to subscriber’s home. E-mails, faxes, phone calls, customer correspondence, and CSW entries also require timely processing.
Responsibilities may be placed on this position that could entail working beyond normal working hours or normal work week due to the many unknowns of the upcoming Exchange and other Health Care Reform provisions, along with unforgiving deadlines and milestones established both by the State of Arkansas and the Federal Government. This position must be flexible and dedicated to getting the job done, as there is much at stake for the Enterprise. (NOTE: During open enrollment, overtime is often times required.)
Handling heavy volumes of work is a significant challenge where timeliness and accuracy are of paramount importance. The Membership Processor must be proficient in the AMISYS system, CSW, FileNet, and MarketWrite.
The Blue Cross and Blue Shield Association, Corporate, and Division policies & procedures, state and federal Exchange enrollment guidelines, the Health Insurance Portability and Accountability Act (HIPAA), Exchange business rules, legislative changes, strict accounting standards, and internal quality standards (MTM) guide the activities of the Membership Processor. Self-guided decisions are based on knowledge gained from experience and continuing education courses provided by the Enterprise. The Membership Processor receives direction from the Membership Specialists, Team Lead, Supervisor and Manager.
Continually changing requirements, legislative changes, and tight time constraints during peak periods represent the most difficult challenges for this position. The Processor must be proficient in the Membership systems and have the ability to access all mainframe systems and screens to perform membership responsibilities. This includes working knowledge of indirect systems that support the membership process such as CSW, FileNet and MarketWrite. The Processor is challenged to meet all internal and external (MTM and CMS Guidelines) enrollment and accounting accuracy and timeliness standards. The Processor is expected to provide excellent customer service, and is trusted to protect customer’s private information and corporate assets.
This position interfaces regularly with the various internal departments such as Customer Service, Regional Internal Service Representatives, Statewide Business team, Claims, Information Systems, and Marketing Representatives regarding questions about eligibility, coverage and/or billing. The position may also be in contact with external contacts including Agent/Brokers, Policyholders, Group Administrators, Pharmacy Vendor, etc.
This position has the authority to recommend and, upon approval, implement changes to improve efficiency and quality to internal and external customers.
Skills, Knowledge and Abilities
1. Ability to demonstrate professional and leadership skills in providing excellent customer service.
2. Must have the ability to learn or have knowledge of Windows, Microsoft Word, Outlook, Excel, Internet Explorer, FileNet, AMISYS, , and CSW.
3. Ability to effectively communicate both orally and in writing.
4. Ability to document and record information such as entry, recording, storing, and maintaining information in written or electronic form.
5. Must be attentive to detail and accuracy.
6. Must be reliable, responsible, and dependable.
7. High level of integrity. Must be able to ensure the security and confidentiality of records and information and be able to work with minimum supervision
Minimum Job Requirements
1. High School diploma or equivalent
2. Office experience
3. Complete Company proficiency tests in math and reading comprehension
4. Customer service experience, either in-person or by phone
5. Experience with Microsoft Word and Excel
6. Minimum typing skills 40 wpm, or 7, 000 keystrokes A/N
This position is identified as level three (3). This position must ensure the security
and confidentiality of records and information to prevent substantial harm, embarrassment,
inconvenience, or unfairness to any individual on whom information is maintained.
The integrity of information must be maintained as outlined in the company Administrative
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented
or detected on a timely basis by employees in the normal course of business. This
position must adhere to the segregation of duties guidelines in the Administrative
PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
1.Data Entry, membership maintenance, daily reports, cancellations, and preparation of refunds, etc.
2. Preparation of fulfillment packets with mailing distribution of these to members.
3.Customer service inquiries and requests, respond to customer enrollment problems, and conduct research as needed.
4.Distribution of mail and reports for section, process cancellations, and perform other duties as assigned.
Arkansas Blue Cross and Blue Shield - 19 months ago
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In 2012, Arkansas Blue Cross was named one of central Arkansas’ “Top Work Places” by the Arkansas Democrat-Gazette and...