The Membership Financial Specialist is responsible for the accurate and timely processing of premium receipts for group and individual business. The position includes duties related to batching & posting of group and individual payments, lock box exceptions, RPO phone pay, RPO Web pay, and credit card payments, individual business reinstatements, address changes, daily balancing of accounts receivable reporting, daily bank deposit preparation, customer bank draft entry and maintenance, refund processing, and insufficient payment research and resolution.
There is considerable customer contact both in person at the Cashier Window assisting walk-in customers, and over the phone responding to payment questions and resolving payment problems. Problem situations consistently require research to bring to resolution. The Incumbent is subject to all Enterprise and divisional standards of quality and performance.
Additional investigation and communication with the groups and members, with direction from the Supervisor , Enterprise Exchange Membership Services, may be required. The Incumbent is subject to all Enterprise and divisional standards of quality and performance.
This position may be asked to interact closely with Information system staff in testing and resolution of system related issues as they occur. There may be a need to support evaluation of system needs and identifying and designing enhancements to support the enrollment and reconciliation process supporting the exchange.
Nature & Scope
The environment is one of teamwork, in which all team members’ work together in order to provide excellent service through timely customer service and payment processing. Work volume is consistently heavy with peak times due to scheduled billings and delinquency deadlines. The position is one of trust due to handling of cash, custody of cash drawers, handling of checks, and protection of customers’ private financial information. Background and credit checks are required on all new employees.
The Specialist may receive trays of incoming group and individual payments on a daily basis. The AMISYS reporting system supplies daily cash maintenance and error reports that must be worked. CSR’s send inquiries and requests via the CSW as well as e-mails and numerous phone calls. Daily correspondence will also include draft authorizations for entry, refund requests, financial adjustments, insufficient checks and drafts, and customer inquiries. Payments are also received via lock box and electronic funds transfer from the bank. The electronic 824 record is received and the subsidy paid by the Federal Exchange is reconciled to the monthly premium billing for each Exchange member.
The incumbent will also work through daily reports from automated upload processes, error reports, customer correspondence and CSW entries from Customer Service. This includes any special reporting that could be received from any of our supporting systems (MarketWrite, Clearinghouse) and the Federal Exchange.
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.)
This position seeks guidance from the Exchange Services leadership team, as well as peers and other internal staff within Arkansas Blue Cross Blue Shield. The incumbent will also work with the training staff and internal QA team to develop and coordinate improvement processes and training opportunities. The Blue Cross and Blue Shield Association, Corporate, and division policies, Health Insurance Portability and Accountability Act (HIPAA), legislative changes, and strict accounting standards also guide the activities of the incumbent. Self-guided decisions are based on knowledge gained from experience and continuing education courses provided by the Enterprise.
The greatest challenges of this position are the continually changing products and rating requirements, legislative changes, and tight time constraints during peak periods. The Membership Financial Specialist must be proficient in the Membership systems and testing, specialty software, and in the research and resolution of group and member billing problems.
The Specialist is challenged to meet all internal and external (MTM and Rule and Regulation 43) enrollment and accounting accuracy and timeliness standards and performance guarantees included in the group contracts. There is also the challenge to ensure compliance standards and guidelines set forth by the federal government are followed closely. Handling significantly heavy volumes of work is a challenge where timeliness and accuracy are of paramount importance.
At times, some of our policyholders can be at times upset and unwilling to accept decisions made by the Plan. Because of this, the incumbent must be careful to maintain a positive image of the company to the public. A great deal of understanding and expertise must also be exhibited when personally handling sensitive situations with the members. As the growth and complexity of the Plan increase, the position becomes more involved. Knowledge of all phases of the corporation must continue to expand in order to keep current with the changes. The position is also challenged with frequent contact and providing excellent customer service with external sources to include Group Administrators, Policyholders, Agent/Brokers, Banking representatives, etc. regarding financial information dealing with very large sums of money.
This position will interface regularly with Exchange Customer Service management and supervisors, Claims, Regional Sales and Marketing, AMISYS Systems, Underwriting/Actuarial, etc. In addition, they routinely have contact with Groups, Contract Holders and Members, Vendors, Banks, etc.
This position has the authority to resolve payment problems, process refunds, maintain customer draft information, and correspond and communicate with customers on payment, refund, draft, and insufficient check resolution situations. This position has the authority to recommend, and upon approval implement changes to improve efficiency and quality of service to internal and external customers. This position has the authority to organize workflow within the Membership area to ensure timely processing and avoidance of backlogs.
The incumbent must possess superior communication skills while developing and maintaining diplomatic rapport with all internal and external customers. Necessary skills require effective writing of memorandums, emails, and complete and thorough documentation of issues with resolution.
Minimum Job Requirements
1. Must meet at least one of the following:
2. Experience in customer service (non-foodservice) or related business office experience in health insurance field
- High school diploma or equivalent with office experience in an accounting or banking field, (i.e. bank teller, cashier, AP clerk, etc.)
- Two (2) years of college (at least 48 credit hours) to include accounting classes and office experience in an accounting or banking field, (i.e. bank teller, cashier, AP clerk, etc.).
- Bachelor's degree from an accredited college or university
3. Keyboarding skills
4. One year working experience utilizing Microsoft Word, Outlook and Excel
5. Complete the company's three proficiency tests in Mathematic Problem Solving; Reasoning; and Reading Comprehension all with above average scores
6. Must pass background/credit check
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. Accurate and timely premium billing reconciliation functions
2. Must have the ability to learn or knowledge of Windows, Microsoft Word, Outlook, Excel, Internet Explorer, FileNet, , BOA Website, and CSW.
3. Ability to listen and comprehend what is being said in both written and spoken word
4. Stay informed of all changes in benefits, regulations, and guidelines.
5. Ability to quickly and accurately compare similarities and differences among numbers, addresses, etc. which may be presented at the same time or one after the other.
6. Accuracy/Attention to Detail - Demonstrates expert knowledge and ability to process information with high levels of accuracy (e.g., displays experience with processing significant amounts of information with high levels of accuracy.
7. Ability to make decisions and solve problems – analyze information and evaluate results to choose the best solution and solve problems.
8. Ability to document/record information – enter, record, store, or maintain information in written or electronic form.
Communicate in a clear and concise manner, both orally and in writing with above average grammar and vocabulary skills.
9. Conduct him/herself in a positive professional and courteous manner at all times with customers and team members.
10. Handle confrontational situations with empathy but also in such a manner reaching fact based and objective conclusions and resolve.
11. Handle confidential information with integrity and professionalism within HIPAA Guidelines.
12. Provide recommendations to management to implement changes improving service and increase customer satisfaction.
13. Interact professionally with all levels of internal staff and customers.
14. Maintain performance levels in order to meet national and divisional performance standards and Plan objectives.
15. Create a solid working relationship with all groups by working directly with contacts as needed to resolve issues.
16. Develop and maintain effective working relationships with other departments/divisions within the enterprise
17. Ability to process significant amounts of information with a high levels of accuracy
18. Ability to use relevant information and individual judgment to determine whether events/process/information comply with laws, regulations and standards. (Including internal, financial institution and federal exchange)
Knowledge, Skills and Abilities
1. Ability to work through and resolve conflict.
2. Ability to multi-task, organize and prioritize workload
3. Above average analytical skills and develop an appropriate solution
4. Ability to work in a structured environment
5. Ability to work independently and contribute to the achievement of service, production, and quality goals of the team.
6. Superior verbal and written communication skills
7. Above average interpersonal skills
8. Ability to act as resource for information and assistance by management and supervisory staff.
9. Ability to professionally represent Arkansas Blue Cross Blue Shield at meetings and other appropriate functions.
10. Must dress and present self in a professional manner.
11. Ability to organize workflow to establish goals and plan for maximum efficiency to achieve those goals.
12. Ability to learn and use PC/Mainframe/Microsoft Office/ Enterprise Support Systems.
13. Ability to remain calm while engaged in a stressful conversation or situation.
14. Ability to identify/research problems and recommend viable solutions.
Arkansas Blue Cross and Blue Shield - 7 months ago