Membership Specialist

Job Summary The Membership Specialist works under the direct supervision of TPA Manager - Client Services, assisting with the eligibility/membership administration of the Self-Funded Health, Dental, Vision and Flex Plan clients. This role is responsible for processing new enrollments, terminations, and changes (adds, drop, life events). Corresponds with appropriate internal and external contacts as needed to resolve any issues and/or concerns. Responds to all inquiries in required time. Duties Process member new enrollments, eligibility, changes, and coverage terminations submitted to RCI Group II, LLC by entering information into the Administration System, verifying eligibility according to the specified resources. Request appropriate information from employer, when needed, to process the membership information submitted. Approve enrollment adds, changes, or terminations submitted through web applications by employer, completing any manual intervention that may be required to finalize the process. Works closely with Prescription Drug Managers directly and/or through their website with Prescription Drug Card issues that may arise as a result of eligibility and/or enrollment. Works closely with Pharmacies directly if member is experiencing problems in filling a prescription. Extract, process, modify, print, and mail notices requested by employers (Medicare D Determination Notices; Proof of Coverage Certificates aka Certificates of Creditable Coverage). Extract, process, print and mail daily Membership notices for new members.

These notices may include:

a) the initial General COBRA Notice; b) initial Coordination of Benefits Notice; c) detailed Coordination of Benefits Notice; d) Medicare D Determination Notices (creditable and non-creditable) and Student Letters for groups who have Dental benefits with eligibility requirements different from Medical benefits. Run process to extract ID Cards from RCI Group II, LLC system daily. After cards have been extracted and submitted to identification card vendor website, the file(s) will be processed through to the vendor. Provides Customer Service regarding Membership in a professional manner. This will be provided using the telephone, web portal submissions, and/or email. Must be able to maintain strict confidentiality of all Protected Health Information (PHI) and client information as well as comply with HIPPA and company policies. Perform other work as may be required. Skills High school diploma or GED. 2 years of general office experience required. 2 years experience within call center, medical, pharmacy, home health, medical terminology required. Knowledge of Third-Party Administrator services or Benefit Administration preferred. Physical Requirements

ESSENTIAL TECHNICAL/MOTOR SKILL

Demonstration of prior work experience in the operation of standard office computer software. Prior data entry computer skills essential. Ability to understand the operation of the in-house computer system and how it relates to the operation of the business. Ability to use various office machines.

PEOPLE SKILLS

Excellent interpersonal and communication skills.

ESSENTIAL PHYSICAL REQUIREMENTS

Must be able to sit for extended periods of time. Must be able to move between offices within the department and to other departments throughout the building. Will include bending, twisting, and reaching. Must be able to kneel, reach, and lift heavy objects (30 lbs.)

ESSENTIAL MENTAL ABILITIES

Able to work independently, managing multiple tasks, analyzing, and assessing while following established policies and procedures and making decisions on the steps to take. Must be able to work in a fast-paced, high pressured work environment. May require over-time hours.

TRAVEL:

Some travel may be required.

EXPOSURE TO HAZARDS

None.

Job Type:

Full-time Pay:

$33,280.00 - $45,760.00 per year

Benefits:

401(k) Dental insurance Flexible spending account Health insurance Health savings account Paid time off Vision insurance

Work Location:

In person