Enrollment Processor (Troy, MI)
Summary – The Enrollment Processor’s primary responsibilities are to review and process eligibility inquiries as well as determine, maintain, and terminate member and/or dependent eligibility for healthcare benefits. The Processor will provide support to the healthcare service team, supervisors, and manager, when necessary.
Essential Duties and Responsibilities include but not limited to
- Understand the plan rules for eligibility as outlined in the Summary Plan Description (SPD)
- Process month end reporting
- Use reports to determine eligibility, reinstatement, or termination of coverage
- Prepare & mail enrollment packages & ID cards for newly eligible members
- Review calc reports and exception reports to update eligibility, as needed
- QA self-payment notices, COBRA notices, status slips, member/dependent letters to ensure accurate information and timely mailing to participants
- Process incoming eligibility documents in OnBase for multiple clients, including but not limited to the following:
- New Member Forms
- Vital Information Forms
- Medicare Information Forms
- Other Insurance Information Forms
- Member/Dependent PHI
- ACH Authorization
- Death Notifications
- Qualified Medical Child Support Orders
- Eligibility Appeals
- Loss of Time Credits
- Enrollment Escalation Requests (Call Center Resolution Form)
- Vendor File Approvals
- Vendor Discrepancy Reports
- Vendor Audit Requests
- Evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules
- Process payments for health & welfare coverage
- Request missing information from members
- Process eligibility escalations within 24 hours and call back members with updates, as needed
- Work with the pension department to ensure H&W deduction amounts are correct and properly setup for retired members and surviving spouses
- Responsible for class code and coverage changes when member’s status changes, such as adding/terming dependents, disability, retirement, or death
- Assist with member walk ins regarding eligibility inquiries
- Understand Medicare rules and regulations to determine eligibility for Medicare benefits and update coordination of benefits in appropriate systems
- Verify and maintain employee demographic information, such as member or dependent address, contact numbers, birth date, social security number, or MBI number
- Comment system with appropriate updates based on documentation received
- Review and approve any plan changes (H&W rate changes, eligibility rule changes, or benefit changes with a vendor)
- Meet daily/weekly quota requirements set by management team
- Update Redbook when necessary, within 24-48 hours of change notification
- Be knowledgeable of policies, procedures, and coverage of various funds
Qualifications - Excellent multi-tasking skills are a must.
Education and/or Experience – High school diploma or GED and at least one year experience with eligibility experience.
Language Skills – Must speak clearly and professionally. Ability to understand directions and follow them to completion of requested task.
Mathematical Skills – General math skills.
Reasoning Ability - Ability to apply common sense to carry out detailed written or verbal instructions
Work Environment - Fast-paced department. Must be able to work independently as well as in a team, must be able to multi-task and must be detailed oriented.
Work Schedule - Full time. Monday - Friday, 7:30am - 4:30 pm. Requires in-office days but also offers at-home flexibility after 90 days.
Competitive Benefits and Compensation Package
- 12 paid holidays
- Paid Time Off (PTO)
- Pro-rated during first year of employment
- 15 days of PTO provided in the next calendar year!
- 3 days paid bereavement
- Up to 20 days paid jury leave
- Medical, dental, and vision insurance, with option for dependent coverage
- Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
- 401k with employer match
- Tuition reimbursement program
- Career development opportunities
- Referral bonus for all successful full-time referrals
- Annual opportunities for increases
Pay - The pay range for this position is $21.00 - $23.00 hourly. Actual salary is dependent on skills, experience, education, and other business factors.
Our Culture
BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
- Collaboration: working together across 31 locations to achieve the best for the company and our clients
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO
Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
