Policy Admin Specialist - Irving, Texas

Job Summary:

The Policy Admin Specialist organizes, maintains, and updates information to ensure members' enrollment and financial premium are current, per employee benefit plan policy. Works on conflicts and rejects related to members' data provided. Handles inbound customer calls from both client and members. Collaborates with the client benefits team to assist with member questions or tasks related to plan policy administration through both verbal and written communication. This position interacts with strategic/key clients which requires providing a specialized and complex service.

Location:

In office position at 8500 Freeport Pkwy Irving Texas 75063

Essential Functions:

The essential functions listed represent the major duties of this role, additional duties may be assigned.

• Enrollment Responsibilities: (40%)
  Processes enrollment updates, changes, adds and terminations either electronically or manually
  Applying premium billing rates and refunds to members' accounts and successfully resolving discrepancy dollars
  Handles client questions and requests regarding eligibility and member premium
  Handles eligibility reports and audits, including daily Financial audits
• Financial Responsibilities: (40%)
  Provides designated team daily client billing report to validate release of NACHA files to the client's bank account.
  Identifies client premium refunds due and prepares refund documentation for processing and payment approval.
  Handles manual list billing by posting and applying payments.
  Reconciles client's bank transactions for premium contributions monthly and for claim payments.
  Organizes and submit invoices to Finance Payments
  Runs monthly financial reporting for reconciliation.
  Processes NACHA file deletions, reversals, and returns.
  Provides requested data for annual audit.
• Customer Service Responsibilities: (20%)
  Answer questions from the client's benefit team and members about enrollment and premium, while ensuring communication always remains courteous and respectful
  Maintain a high accuracy level by providing complete and accurate information at all times
  Document notes of each call to ensure all information is saved correctly
  Abide by all Customer Service Goals as set by the Manager of the department
  Maintains a positive relationship with the client benefits team

Qualifications:

• 5+ years related work experience in Enrollment, Customer Service, Financial, Claims Processing, or other related Health Insurance Administration experience
• Must be a self-starter with the ability to identify problems/issues and offer workable solutions.
• Ability to prioritize or seek information on how to best prioritize projects.
• Project confidence, high energy, enthusiasm, and high regard for client advocacy and service.
• Strong verbal and written communication skills; ability to tailor communications based on audience and business objectives.
• Comfortable working and communicating across operational areas and working in cross-functional teams
• Maintain confidentiality and observe HIPAA and PHI requirements
• Ability to effectively communicate with clients and executives in a confident manner.

Additional Preferred Qualifications:

Work experience with employee health plan policy administration

Experience working with DataPath Summit or other premium billing processing software

Required Education:

High school diploma or GED

Preferred Education:

Bachelor's degree in a related field

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.