Under limited supervision, the COBRA and Premium Billing Specialist performs all phases of billing services and compliance administration in accordance with government regulations, company and departmental procedures and standards. This position will provide quality customer service interactions with clients, sales associates, brokers, and continuants/retirees.

These duties must be performed in a timely manner consistent with our established performance standards and client specific performance guarantees as required

ESSENTIAL FUNCTIONS

• Coordinates and administers assigned case load pursuant to service level agreements and compliance requirements
• Communicate with clients, brokers, insurance carriers, TPAs and other vendors via phone and email to resolve and troubleshoot participant issues and provide clarification in accordance with department standards (within 1 business day).
• Maintain, process and update participant’s accounts including benefit change and payment allocations within P&A’s software
• Ensure participant changes, enrollments, and cancelations are processed timely and accurately with the insurance carriers/clients
• Coordinate plan open enrollment tasks to ensure software parameters are set in accordance with the client’s pertinent benefit and carrier information
• Perform open enrollment tasks including updating rates, benefits, carrier information, and invoicing participants
• Assist and support Participant Support Center and data team with plan questions and escalated issues
• Exercise independent judgement on a limited basis related to billing and eligibility taking into consideration P&A procedures and policies, carrier policies, government regulations, and client guidelines
• Additional responsibilities may include training, new case implementation, and providing direction and assigning tasks to others as appropriate.
• Keeps the Group Insurance Supervisor fully informed on all problems or unusual matters of significance and escalates when necessary

OTHER FUNCTION(S)

• Champion P&A’s Values and Policies.
• Maintain data protection, privacy, security and maintain HIPAA compliance for participants and clients.
• Completes any additional assignments as requested by the executive/management team members.
• Provides back up to peers as required
• Assists with documenting processes and procedures
• Ad-Hoc reporting, analysis and presentations as required.
• Other duties as assigned

EDUCATION / EXPERIENCE

• High School Diploma or Equivalent

SKILLS/KNOWLEDGE/COMPETENCIES

• Knowledge of Federal and State COBRA laws and eligibility laws
• Knowledge of HIPAA with thorough understanding of HIPAA portability provisions and HIPAA privacy and security rules
• Thorough knowledge of all internal processes and software applications related to Group Insurance Department functions
• As competence and job knowledge grows, provide training, guidance and support to less senior colleagues
• Solid oral and written communication skills with ability to convey a message with diplomacy and tact
• Ability to effectively interact, present information, and respond to questions from customers, colleagues and management
• Ability to effectively manage multiple priorities utilizing effective organizational and time management practices
• Basic understanding of accounting principles related to AR/AP
• Strong computer skills, including Microsoft Office Suite

TRAVEL

• With advance notice, occasional overnight and business day travel may be required for this role.

WORKING CONDITIONS

• Fast-paced work environment; flexibility to work schedules as required due to changing business demands. Occasional overtime is required. The work environment is moderately sedentary and typical of general office conditions with regard to standing, sitting, walking and lifting; no adverse conditions.
• An equal opportunity employer and a smoke, drug and alcohol-free workplace.

OTHER

• Complete any additional assignments and projects as requested by management.
• This job description is designed to cover a general list of responsibilities and expectations for this role and does not contain a complete listing of activities, duties or responsibilities that are required for the role. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time with or without advance notice.

EOE