Health Insurance Operations Specialist

Overview
We are seeking a passionate Operations Specialist to join our team and support our enrollment, call/service, claim and general operations. If you have health insurance experience or medical office experience, a knack for managing details, the desire to delight customers and the ability to navigate change, growth and challenges with grace, we want to hear from you! We are especially looking for experienced candidates interested in working later hours such as 10am - 7pm or 11am - 8pm (either consistently or on a rotational basis) as our hours may soon be expanding to meet the needs of our members on the West coast.

General duties...although no two days look the same at our new and growing company!

• Assist with the overall claims process, ensuring claims are tracked and managed through the entire cycle; review work queues for processing exceptions and investigate/clear as needed; monitor member progress toward deductible; investigate and resolve claims inquiries from members and providers; assist with operational and performance reporting for claims
• Key and process paper claims; log into tracking system, scan and file (physically and electronically) paper copies
• Generate and distribute Explanation of Benefits (EOB) documents to members
• Generate and distribute Provider Remittance Advice (PRA) documents to providers; prepare payments for approval and signature
• Greet and route/assist inbound callers and conduct outbound calls as needed
• Speak with members, providers and general public by phone, email and online chat, assisting and resolving as situationally required, and logging into tracking system
• Assist with operational and performance reporting for calls, emails and chats
• Generate and distribute agent compensation reports; prepare payments for approval and signature
• Generate and distribute member repayment statements; monitor accounts and generate invoices; apply payments
• Process member and group enrollments and disenrollments; research group applicants' business standing
• Prepare beneficiary enrollment materials for approved groups
• Generate and distribute beneficiary/member materials such as ID cards, enrollment verification letters, disenrollment letters and other member-related communications during the plan year
• Process agent certifications; research agent's licensing standing and progress them through the certification process
• Monitor agent licenses, insurance and certification statuses; notify agents of upcoming expirations and obtain new/revised licenses/insurance/certification certificates
• Assist with processing and managing grievances and organization/coverage determinations
• Assist with processing and managing training and compliance programs
• Open and process/route received mail
• Coordinate outbound mailings - assist with printing, folding, stuffing, metering
• Support sales staff by coordinating shipping and logistics for conferences and events
• Support office staff by monitoring supplies and office equipment, and requesting orders/resupplies as necessary
• Create operational documents and processes as needed
• Assist with identifying, planning and potentially configuring business-layer updates to supporting software packages (e.g., CRM, etc.) as needed

Required Skills:

• At least two years of claims processing, member or provider service, member enrollment or claims billing experience in health provider or health insurance settings
• Strong personal leadership and task management abilities to coordinate operational tasks effectively
• Detail-oriented
• Customer service-oriented approach to interactions with members and providers
• Proficiency in English for clear communication with team members, members and providers
• Proficiency with Microsoft and Google business applications

Nice-to-have Skills:

• Experience with Zoho business applications
• Proficiency in Spanish

Job Type: Full-time

Pay: $20.00 - $28.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Evening shift
• Monday to Friday

Work Location: In person