Job Information
WorkSource Oregon Individual Membership Representative II in Springfield, Oregon
Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! DUTIES - Process individual enrollments, changes, terminations, APTC status updates, for subscribers and dependents. This will be maintained through Enrollment Management System (EMS), Facets and through monthly audits including but not limited to the FFM Pre-Audit file. - Answer incoming calls, documenting each call in Facets. - Audit and review new policies and all pertinent documents using systems including PacificSource Enterprise (PSE), OnBase, Enrollment Management System (EMS) and SEED. - Process Discretionary Billing Items, refunds, cash transfers, and write offs as needed following Centers for Medicare & Medicaid Services (CMS) regulations. - Monitor and process appeals and escalated cases from the Federal Exchange via HICS (Health Insurance Casework System). - Monitor e-mail queue and provide e-mail support to agents, members and internal customers regarding eligibility, status of applications and other various requests. - Generate correspondence following company and Exchange guidelines, ensuring consistency and accuracy. - Maintain accuracy standards as required to meet department and PacificSource PRISM measures. Complete all daily, weekly, bi-monthly and monthly reports for active and terminated members. - Electronically upload images into imaging system. Prepare documents for manual imaging if needed. - Maintain data alignment with the Federal and State Based Exchanges. Working monthly audits in addition to any other audits that are presented. - Set up and maintain transactions including Electronic payments, Electronic Fund Transfer (EFT) records, Recurring Payments, Insufficient funds in system. Audit file of electronic funds transfer transactions. - Conduct testing and provide feedback for system upgrades/enhancements, special projects REQUIREMENTS - Minimum of two years prior customer service, medical insurance or other healthcare related experience required. PacificSource Individual Membership Rep 1, insurance or healthcare experience preferred. - High School diploma or equivalent required. - Must possess excellent communication skills both verbal and written, intermediate excel knowledge, strong keyboarding skills, problem solving skills and being able to multi-task. - Effectively articulate rates, contract provisions and processes to internal and external customers. - Adhere to company and department policies and meet expectations for service, accuracy and efficiency. - Define and prioritize problems and manage workload without direct supervision. HOURS & PAY Full-time; Pay depending on experience and qualifications