The Membership Processor, Individual Accounts is responsible for accurate and timely processing of enrollment additions, changes, cancellations, reinstatements, prepare refunds, calculate surcharges, and QA reviews of system entry. The position includes duties related to verification of data entry of information into the MemBRS systems. Providing excellent customer service in contact with internal and external customers is a major responsibility of the incumbent including the necessary research in MemBRS to respond to the customer. The incumbent 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 and accurate enrollment processing, quality assurance reviews, and customer service. Work volume is consistently heavy with peak times during seasons when sales activity is particularly heavy such as following new product offerings. Product rate increases can give rise to a heavy volume of change and cancellation requests.
The Membership Processor receives applications and change forms on a daily basis for system entry. The incumbent also works through daily reports from our automated upload processes, MemBRS error reports, and the dental upload error reports. E-mails, faxes, phone calls, customer correspondence, and CSW entries also require timely processing.
The Blue Cross and Blue Shield Association, Corporate, and Division policies & procedures, underwriting enrollment guidelines, the Health Insurance Portability and Accountability Act (HIPAA), individual business Policies, legislative changes, and strict accounting standards 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 Supervisor and Manager, and authorization for actions is frequently dependent on Underwriting and Regional Office approvals.
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 MemBRS system, CSW, FileNet, and MarketWrite. The Specialist 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 & External Service Reps, Individual Underwriting, Individual Marketing, Benefits Administration, etc. The position also has frequent contact with a variety of external contacts such as Agents/Brokers, Policyholders, Group Administrators, Dental Vendor, etc.
This position has the authority to apply enrollment guidelines, resolve individual enrollment and payment problems, process refunds, and correspond and communicate with customers as necessary. 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/Customer Accounts area to ensure timely processing and avoidance of backlogs.
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 by phone.
5. Minimum typing skills 40 wpm, or 7,000 kph.
MEMBERSHIP PROCESSOR - Individual Accounts
Grade 7-8 Progression
Requirements - Grade 8
Meet grade 7 requirements plus the following:
Meet upgrade criteria per Administrative Manual
Complete Service Excellence and apply principles and skills
Commendable Interpersonal Skills
Complete Business Grammar Class
Demonstrated ability to work in a team environment
Demonstrated ability to work independently
Ability to be a self-starter, actively influence events to achieve goals, and take action beyond minimum required for the position
Demonstrated ability to multi-task, organize, and prioritize
Ability to work with minimal supervision
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)
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 knowledge of Windows, Microsoft Word, Outlook, Excel, Internet Explorer, FileNet, ORS, CIMR, and CSW.
3. Ability to effectively communicate both orally and in writing.
4. Ability to identify a problem, review related information to develop and evaluation options for a solution.
5. Ability to document and record information such as entry, recording, storing, and maintaining information in written or electronic form.
6. Must be attentive to detail and accuracy.
7. Must be reliable, responsible, and dependable.
8. 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
1. Data Entry, membership maintenance, daily reports, cancellations, and preparation of refunds, etc.
2. Customer service inquiries and requests, respond to customer enrollment problems, and conduct research as needed.
3. Distribution of mail for section, process cancellations, and perform other duties as assigned.
Arkansas Blue Cross and Blue Shield
- 21 months ago - save job
In 2012, Arkansas Blue Cross was named one of central Arkansas’ “Top Work Places” by the Arkansas Democrat-Gazette and...