Membership Eligibility Processor I, II, or III DOE
Cambia Health Solutions

Job Info

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Membership Eligibility Processor I, II, or III DOE

Remote in WA, ID, and OR

Primary Job Purpose:

The Membership Eligibility Processor establishes and maintains accurate subscriber and member level eligibility through processing new applications, member additions and deletions, policy revisions, demographic changes, renewal changes, and any other maintenance affecting eligibility.

Normally to be proficient in the competencies listed below:

This individual would have a high school diploma or GED and a demonstrated ability to meet or exceed accuracy and production standards, or an equivalent combination of education and job-related work experience.

Responsibilities:

• Process group enrollment applications for Individual, Small, Large, Trust, and Specialized groups.
  
• Calculate appropriate waiting period credit, eligibility data, and effective date, and enter benefits, bank draft identification information, demographics, family members, and primary care physician information with network coding, while maintaining consistency with the contract in place.
  
• Review, maintain and enter changes on Individual and/or Group & Trust accounts which may include change of effective date(s) for subscriber coverage or subscriber dependents, addition or deletion of insured or dependents from coverage, etc.
  
• Acquire information required to complete application processing such as calling an employer, member or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan.
  
• Meet MTM and State requirements by prioritizing work load and performing tasks accurately and timely.
  
• Generate group or individual billings and order member ID cards.
  
• Ensure current State and Federal policies and procedures are met by incorporating and applying essential changes made to Membership Accounting and Underwriting.
  
• Meet established departmental performance expectations, including but not limited to ensuring member confidentiality.
  
• Align with MTM standards as well as Consortium standards as they relate to group membership activities.
  
• Handle responses to inquiries to meet BlueCross and BlueShield Association (BCBSA) standards and company goals.
  
• Provide customer service to internal customers, and place/track outgoing calls to external customers including groups, agents and subscribers to acquire information vital to enrollment.
  
• Review and apply eligibility rules for trust employees.
  
• Assist newer team members with questions on complex issues or accounts as needed.
  
• Assist Membership Lead and Supervisor as appropriate.
  
• Maintain manuals to ensure policies and procedures are current.
  
• Attend and participate in training and staff meetings.
  

Minimum Requirements:

• 40 wpm keying.
  
• 10-key by touch.
  
• Must be meticulous and self-motivated and possess strong communication skills.
  
• Must be dependable and maintain attendance at or above departmental standards.
  
• Possess the ability to exercise judgment, initiative and discretion in a confidential, mature and sensitive manner.
  
• Establish effective working relationships with staff and customers.
  
• Possess basic math skills.
  
• Ability to organize and prioritize work.
  
• PC experience required; experience with Word, Excel, and Outlook or similar software.
  
• Medical Terminology for WSHIP health questionnaire processors required.
  

Work Environment:

• Repetitive actions of using a PC keyboard and mouse.
  
• Sitting at workstation for extended periods of time.
  
• Willing to work overtime and on weekends when needed.
  

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

Information about how Cambia Heath Solutions collects, uses, and discloses information is available in our Privacy Policy.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

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