Health Alliance Plan Hiring for Specialist – Government Membership and Billing – Health Alliance Plan at Southfield, MI Full Time

GENERAL SUMMARY:
The Government Membership and Billing Specialist is responsible for processing Government Programs membership activity, including Medigap, Medicare Advantage, Prescription Drug Plan and Marketplace product lines, within federally mandated regulations. Responsibilities include enrollment and billing reconciliation, reconciling enrollment discrepancies and working with Sales, Client Services, Finance and Medicare Operations to ensure customer satisfaction.

PRINICIPAL DUTIES AND RESPONSIBILITIES:
Process enrollment transactions, including resolving incomplete elections, transaction reply reports from CMS and investigating enrollment discrepancies.

Resolve financial discrepancies, including member inquiries, payment processing errors, and Monthly Premium Withhold Report and issuing refunds.

Review/resolve demographic, enrollment and financial discrepancies and report errors to CMS for resolution.

Participate in cross functional work groups to resolve process failures, create process improvement and share with team.

Provide verbal and written assistance to member services, marketing, and other internal departments as well as employer group representatives, regarding HAP senior plus direct pay members

Process Ika queues as assigned.

EDUCATION/EXPERIENCE REQUIRED:
High school diploma or equivalent

Two-year Associate Degree in Business related field preferred.

One (1) year experience in Membership & Billing, customer service, or claims department is required.

Math skills and entry level accounting skills

Working knowledge of Facets and Pega systems.