Enrollment Technician

Details
Type: Current Job Openings

Requirements

  • 1-2 years of office experience and High School Diploma or equivalent. Prior insurance experience preferred.

General Purpose

To accurately process initial enrollment and maintenance to contracts, efficiently add on new groups, and process group renewals, following all contract guidelines, company policies as well as State and Federal laws.

Essential Duties & Responsibilities

  • Works towards quality initiatives.
  • Determine completeness and timeliness of applications for processing following the eligibility guidelines as outlined in the corresponding benefit document.
    • Code, pend, and enter all applications into the system.
      • Update all member limits relating to portability, coordination of benefits, etc.
    • Send letters on incomplete applications and perform any necessary follow-up.
  • Process changes and related correspondence to subscriber policies subsequent to initial enrollment.
    • Terminate coverage for members and/or dependents that are losing eligibility for group and/or individual enrollment including COBRA/Mini-COBRA coverage.
      • Ensure appropriate continuation of coverage is offered if applicable.
    • Process address, name, release of information forms, student verification, returned bank items, portability, coordination of benefits.
    • General understanding of the adjustments relating to the changes being processed.
  • Accurately and efficiently add new group and renewals to the system, adhering to all Association standards for accuracy and timeliness.
    • Process group cancellations.
    • Process general group maintenance.
    • Mail contracts to groups upon initial enrollment and renewal.
  • Establish and accurately maintain files for COBRA and Mini-COBRA enrollees.
    • Ensure all necessary notices are sent out in a timely manner during a member’s continuation period.
    • Prepare and send monthly COBRA eligibility and pure premium reports.
  • Prepare welcome letters and packets with all appropriate materials, adhering to all Association timeliness standards.
    • Copy applications and distribute to appropriate departments.
  • Prepare billing audits for groups and/or members.
  • Correspond in writing, via telephone, and through e-mail with salespeople, groups, internal staff, and applicants regarding eligibility, incomplete applications/changes, and billing questions.
  • Good working knowledge of BOLTS systems.
  • General understanding of laws and regulations, both State and Federal, pertaining to insurance membership maintenance as well as interpretation of contract language (COBRA, HIPAA, PPACA, ERISA, COB, and State statutes regarding fully insured business).
  • Process inter-plan transfers of coverage adhering to Association guidelines.
    • Correspond via telephone and through e-mail with other BCBS plans regarding inter-plan transfers.
  • Work various reports in a timely manner such as Application Control, Application Tracking Spreadsheets, Cycle 9, CCC Errors, Medicare Maintenance, and Student Max Age.
  • Distribute daily:
    • Departmental reports.
    • Incoming mail.
    • ID cards to internal staff.
  • Prep applications and correspondence files for scanning.
  • Quality Control of applications, member changes, letters, group set-up and renewals.

Other Duties & Responsibilities

  • Handle correspondence, inquiries and research regarding the above-mentioned responsibilities, adhering to all Association standards for timeliness.
  • Complete required forms such as backlogs and workload monitors.
  • Other duties as assigned.
  • Special projects as needed.
Supervisory Duties

None.

Job Qualifications

Knowledge, Skill & Ability
  • Typing 40 WPM accurately
  • Telephone Skills
  • Understand legal and contractual language
  • Work subject to specific performance and accuracy guidelines
Education, Licensure, or Formal Training

High School Diploma or equivalent

Experience

One to two years office experience. Prior insurance experience preferred

Equipment & Environment

Material & Equipment Directly Used
  • LAN PC Network
  • Word Processing Software (Word)
  • Spreadsheet Software (Excel)
  • 10-Key adding machine
  • Fax Machine
  • Database Software (Access)
Working Environment / Physical Activities

Work in an open office environment.

Access to Protected Health Information (PHI)

Access to Protected Health Information (PHI) will be limited to that which is necessary to carry out job duties outlined above.

Notes & Other Information

Position summary shown may not include ALL of the necessary knowledge, skill, and ability requirements.

Note: Position summary shown may not include ALL of the necessary knowledge, skill, and ability requirements.

Blue Cross Blue Shield of Wyoming
EOE M/F/Vet/Disabled Employer
E-Verify

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