The Membership Processor is responsible for accurate and timely enrollment and maintenance of groups and members. This includes additional investigation and communication with internal and external customers in order to obtain necessary information to complete the enrollment. The Processor is subject to all Enterprise and divisional standards of 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 enrollment and maintenance of groups and members, distribution of member ID cards and benefit materials, and billing and reconciliation of monthly premium for all product lines.
The Group Enrollment Information (GEI)/Group Master form is received from Membership Specialist. Adds/changes and monthly premium are received from Employer Groups on a daily basis through incoming mail, fax or electronically. Subscribers and members are entered; ID cards are verified and mailed with benefit materials.
Corporate and division policies, Health Insurance Portability and Accountability Act (HIPAA), Group Contracts/ASO Agreements and Evidence of Coverage/Certificate of Coverage/Plan Documents, legislative changes, and strict accounting standards guide the activities of the Membership Processor. Self-guided decisions are based on knowledge gained through from on-the-job training and experience and through Enterprise offerings and division in-service training. The Membership Processor receives direction from the Membership Specialist, Supervisor and Manager.
Continually changing group 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. The Processor 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.
This position interfaces regularly with Customer Service, Claims, Regional Sales and Marketing, Information Systems, etc. In addition they have contact with Employer Groups, members, Vendors, etc.
This position has the authority to determine eligibility for members, administer preexisting on members and make refund adjustments. The Membership Processor has the authority to contact Group Administrators, Marketing Representatives, Customer Service staff, Claims, IS, and Regional Office staff when there is a question about coverage, benefits, or PCP assignments. This position has the authority to recommend and implement changes to improve efficiency and quality of service to internal and external customers.
The Processor must be able to provide support for system testing and system changes and new releases and to use various accounting software and programs to perform accounting
Minimum Job Requirements
1. High diploma or equivalent.
2 Complete company proficiency test for reading, typing (40 wpm) or 6,000 kph, math and alphabetical order
3. Data entry experience or membership experience
Requirements - Grade 8
Meet grade 7 requirements plus the following:
Meet upgrade criteria per Administrative Manual
Completion of internal training on membership maintenance functions, system inquiry, inquiry tracking system and required software applications
Commendable Interpersonal Skills
Complete Business Grammar Class
Ability to effectively communicate with internal and external customers
Demonstrated ability to work in a team environment
Demonstrated ability to work independently
Ability to be a self-starter and take action beyond minimum required for the position
Demonstrated ability to multi-task, organize, and prioritize
Ability to work with minimal supervision
Demonstrated ability for accuracy and detail
Proficient with all required systems and software applications
Demonstrated good problem solving and decision making skills
Meet performance and QA standards for the most recent 6 months
Minimum time in previous grade 7: 12 months
8. Meet performance and QA standards for the most recent 6 months
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. Enrollment of groups and members - Data Entry or up-dates and new member information, Update student and COB information, Process phone log/inquiry tracking report, process benefit materials and ID cards, Post premiums and reconcile group bills.
2. Customer Service and Research - Contact Employer Groups and Contact Marketing Representatives as needed, correspond with groups for eligibility and billing, Research inquiries/problems and provide timely response, etc. 3. Serve as a resource for new staff, Maintain desk procedures for assigned job, Serve as backup for other Processors as assigned. 4.Perform other duties as assigned.
Arkansas Blue Cross and Blue Shield - 12 months ago
In 2012, Arkansas Blue Cross was named one of central Arkansas’ “Top Work Places” by the Arkansas Democrat-Gazette and...