COBRA & Premium Billing Administrator I
Capital District Physicians Health Plan Inc, Binghamton, NY, United States
Job Description
Summary: The COBRA & Premium Billing Administrator responds to and resolves written, telephone, and personal inquiries from clients and/or subscribers concerning policies and procedures in a professional and efficient manner. This position coordinates and monitors daily activities for COBRA and Third-Party Premium Billing Administration to ensure regulatory requirements and established standards and deadlines are met.
Client Team
Serves as a point of contact for clients and brokers in relation to the day‑to‑day operational tasks including, but not limited to, responding to client and broker inquiries/requests; scheduling, facilitating, and delivering client reporting; processing member refund requests; managing open enrollment requests; monitoring member grace periods, managing member payment requests, reviewing and reporting on member payment status.
Responds to client/broker inquiries on a timely basis within department service standards. Notifies and educates clients of any rules or regulation changes.
Conducts webinar demonstrations and supports client and broker training of the software system and portal functionality.
Manages the rate renewal process for assigned clients.
Participates in client and broker requested conference calls.
File Team and Enrollment
Responsible for the processing of the inbound and outbound departmental file exchanges within the service standards. Files are primarily membership files that require adding, updating, or deleting subscriber group data within the software system. Responsible for processing any identified error or no‑load files.
Responsible for the coordination and execution of the daily carrier file for member coverage reinstatements, changes, and terminations.
Coordinates and collaborates with the LBS EDI team to proactively identify and resolve any file errors.
Communicates with client, broker, or vendor(s) to resolve file related processing issues.
Supports the process of establishing and testing new client files.
Monitors and documents each respective carrier preferred eligibility process.
Works with carriers to assure all billing activities meet the needs of the client and the carrier.
Level I Accountabilities
Maintains knowledge of rules, regulations, policies, and benefits governing COBRA and Premium Billing.
Administers group plans in accordance with all appropriate regulations and processes all activity within service time standards.
Supports customer service team in answering or researching member inquiries. Researches, interprets, and responds to inquiries in a professional and efficient manner using problem‑solving skills.
Processes member requests not facilitated through software vendor, including but not limited to member payments, banking forms, enrollment and termination forms.
Assists in system and release testing and troubleshooting.
Performs departmental and team functions according to established desk level procedures (DLP). Participates in the development, updating, and monitoring of DLP.
Participates in ongoing training to further knowledge of regulations, software systems, policies and procedures, and develops skills to accurately fulfill requirements of the job.
Consistently meets the established departmental and team productivity metrics. Successfully satisfies the assigned tasks and standards of the inter‑departmental team assignments.
Maintains current knowledge of LBS policy and procedures.
Consistently demonstrates high standards of integrity by supporting the Lifetime Benefit Solution's mission and values, adhering to the Corporate Code of Conduct and the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs functions as assigned by management.
Level II Accountabilities (in addition to Level I)
Performs advanced research and resolution of inquiries and adjustments on behalf of clients, brokers or carriers.
Assists in resolution of escalated or systematic issues. Proactively identifies error trends.
Assists in client audits and data comparisons.
Services strategic accounts and complex COBRA and Premium Billing accounts.
Serves as a resource to other team members.
Minimum Qualifications
Level I
High School diploma or equivalent. Associate degree in business administration or related field preferred.
Two or more years of related experience.
Knowledge of COBRA rules and regulations preferred.
General understanding of medical, dental, vision, and Medicare benefits.
Excellent problem‑solving, reasoning, and organizational skills. Ability to manage multiple projects.
PC experience including knowledge of Microsoft Word and Excel.
Excellent oral and written communication skills.
Ability to communicate effectively while working collaboratively and maintaining positive relationships with clients.
Ability to work in a team environment as well as independently.
Level II (in addition to Level I)
Four or more years of experience working in COBRA and Premium Billing industry.
Strong knowledge of COBRA and Premium Billing rules and regulations.
Demonstrated problem‑solving and ability to resolve complex inquiries or escalated situations.
Advanced knowledge of departmental software system and Excel.
Physical Requirements
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
Compensation
Minimum: $20/hr - Maximum: $26.90/hr
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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Summary: The COBRA & Premium Billing Administrator responds to and resolves written, telephone, and personal inquiries from clients and/or subscribers concerning policies and procedures in a professional and efficient manner. This position coordinates and monitors daily activities for COBRA and Third-Party Premium Billing Administration to ensure regulatory requirements and established standards and deadlines are met.
Client Team
Serves as a point of contact for clients and brokers in relation to the day‑to‑day operational tasks including, but not limited to, responding to client and broker inquiries/requests; scheduling, facilitating, and delivering client reporting; processing member refund requests; managing open enrollment requests; monitoring member grace periods, managing member payment requests, reviewing and reporting on member payment status.
Responds to client/broker inquiries on a timely basis within department service standards. Notifies and educates clients of any rules or regulation changes.
Conducts webinar demonstrations and supports client and broker training of the software system and portal functionality.
Manages the rate renewal process for assigned clients.
Participates in client and broker requested conference calls.
File Team and Enrollment
Responsible for the processing of the inbound and outbound departmental file exchanges within the service standards. Files are primarily membership files that require adding, updating, or deleting subscriber group data within the software system. Responsible for processing any identified error or no‑load files.
Responsible for the coordination and execution of the daily carrier file for member coverage reinstatements, changes, and terminations.
Coordinates and collaborates with the LBS EDI team to proactively identify and resolve any file errors.
Communicates with client, broker, or vendor(s) to resolve file related processing issues.
Supports the process of establishing and testing new client files.
Monitors and documents each respective carrier preferred eligibility process.
Works with carriers to assure all billing activities meet the needs of the client and the carrier.
Level I Accountabilities
Maintains knowledge of rules, regulations, policies, and benefits governing COBRA and Premium Billing.
Administers group plans in accordance with all appropriate regulations and processes all activity within service time standards.
Supports customer service team in answering or researching member inquiries. Researches, interprets, and responds to inquiries in a professional and efficient manner using problem‑solving skills.
Processes member requests not facilitated through software vendor, including but not limited to member payments, banking forms, enrollment and termination forms.
Assists in system and release testing and troubleshooting.
Performs departmental and team functions according to established desk level procedures (DLP). Participates in the development, updating, and monitoring of DLP.
Participates in ongoing training to further knowledge of regulations, software systems, policies and procedures, and develops skills to accurately fulfill requirements of the job.
Consistently meets the established departmental and team productivity metrics. Successfully satisfies the assigned tasks and standards of the inter‑departmental team assignments.
Maintains current knowledge of LBS policy and procedures.
Consistently demonstrates high standards of integrity by supporting the Lifetime Benefit Solution's mission and values, adhering to the Corporate Code of Conduct and the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs functions as assigned by management.
Level II Accountabilities (in addition to Level I)
Performs advanced research and resolution of inquiries and adjustments on behalf of clients, brokers or carriers.
Assists in resolution of escalated or systematic issues. Proactively identifies error trends.
Assists in client audits and data comparisons.
Services strategic accounts and complex COBRA and Premium Billing accounts.
Serves as a resource to other team members.
Minimum Qualifications
Level I
High School diploma or equivalent. Associate degree in business administration or related field preferred.
Two or more years of related experience.
Knowledge of COBRA rules and regulations preferred.
General understanding of medical, dental, vision, and Medicare benefits.
Excellent problem‑solving, reasoning, and organizational skills. Ability to manage multiple projects.
PC experience including knowledge of Microsoft Word and Excel.
Excellent oral and written communication skills.
Ability to communicate effectively while working collaboratively and maintaining positive relationships with clients.
Ability to work in a team environment as well as independently.
Level II (in addition to Level I)
Four or more years of experience working in COBRA and Premium Billing industry.
Strong knowledge of COBRA and Premium Billing rules and regulations.
Demonstrated problem‑solving and ability to resolve complex inquiries or escalated situations.
Advanced knowledge of departmental software system and Excel.
Physical Requirements
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
Compensation
Minimum: $20/hr - Maximum: $26.90/hr
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
#J-18808-Ljbffr