Membership Representative II
Elevance Health

Job Info

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Membership Representative II

Must be located within 50 miles of Norfolk, VA

The Membership Representative II is responsible for enrollment, billing activities and/or maintaining assigned accounts. Must be able to successfully perform all the duties of the Membership Rep I.

How you will make in impact:

• Responds to incoming calls and may initiate outgoing calls, providing customer service to plan members, providers and employer groups by answering benefit questions, resolving issues and educating callers.
  
• Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections; addresses a variety of enrollment questions and/or concerns received by phone or mail.
  
• May be responsible for billing and delinquency processes for assigned groups.
  
• Ensures accuracy and timeliness of the membership and billing function. Responds to inquiries concerning enrollment processes.
  
• Maintains enrollment database.
  
• May order identification cards.
  
• Determines eligibility and applies contract language for each case assigned.
  
• Performs error output resolution for electronic eligibility and processes error discrepancy lists.
  
• Maintains and reconciles premium bill, self-bill and individual billed accounts. Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.
  
• Screens all forms and data for all paperwork received from Sales and/or Underwriting for new group and/or group re-classing benefits.
  
• Makes request to Underwriting, Sales or Brokers for missing information and/or forms needed for new group or re-class of existing group.
  
• May be responsible for loading rates for new groups and renewal/re-class groups within the appropriate system.
  
• Screens group for benefits to determine if existing or new, recognizing when benefits are not standard and handling as appropriate.
  
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
  
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
  

Minimum Requirements:

• Requires high school diploma or GED and a minimum of 1 year relevant healthcare customer servicing experience which includes a minimum of 1 year membership experience with the company; or any combination of education and experience which would provide an equivalent background.
  

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