Membership Billing Rep - TPA Job Listing at Medical Mutual in Brooklyn, OH (Job ID 2400119)

Description

The Membership Billing Representative - TPA position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, OH Medical Mutual office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Medical Mutual' s status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

Under general supervision, provides administrative support in the membership and billing areas. Maintains member health plan records and sends monthly invoices to clients for administration fees associated with their employee benefit plan.  Functions as the first point of contact for internal clients, groups and brokers regarding routine to moderately complex eligibility and billing inquiries.

Responsibilities

Membership Billing Representative I - TPA

·         Processes routine and/or less complex member enrollment transactions such as address, name, etc.

·         Prepares routine product invoices and reports.

·         Reviews/updates open enrollment changes such as Coordination of Benefits (COB), dependent updates, etc.

·          Reviews and approves enrollment information submitted by customers via the secured website within expected turnaround times.

·          Coordinates and documents correspondence and distribute into workflow.

·          Researches and responds to routine inquiries via fax, postal mail or e-mail.

·          Performs other duties as assigned.

Membership Billing Representative II - TPA

·    Processes routine to moderately complex member enrollment transaction such as additions, terminations, etc.

·    Prepares routine to moderately complex invoices and reports.

·    Reviews/updates open enrollment changes such as Coordination of Benefits (COB), dependent updates, etc.

·    Researches and responds to routine inquiries via fax, postal mail or e-mail regarding eligibility feeds and files, and eligibility issues on vendor websites (i.e dental, RX, vision).

·    Executes system test plans/scripts, system upgrades, and/or new releases.

·    Participates occasionally in onsite and phone client implementation meetings to provide sales support.

·    Reviews and approves enrollment information submitted by customers via the secured website within expected turnaround times.

·    Coordinates and documents correspondence and distributes into workflow.

·    Orients, trains, and assists more junior level Representatives.

·    Analyzes deficiencies in processes/procedures and recommends improvements to more senior levels.

·    Performs other duties as assigned.

Sr. Membership Billing Representative - TPA

·    Processes routine to varied and/or complex member enrollment transactions such as group additions, terminations, renewals, etc.

·    Prepares routine to varied and/or complex invoices and reports.

·    Reviews/updates open enrollment changes such as Coordination of Benefits (COB), dependent updates, etc.

·    Researches and responds to routine to varied and/or more complex eligibility inquiries via fax, postal mail or e-mail regarding eligibility feeds and files, and eligibility issues on vendor websites (i.e dental, RX, vision).

·    Creates and executes system test plans/scripts, system upgrades, and/or new releases.

·    Participates frequently in onsite and phone client implementation meetings to provide sales support.

·    Verifies proper and timely review and approval of enrollment information submitted by customers via the secured website within expected turnaround times. 

·    Verifies proper coordination and documentation of correspondence and distribution into workflow.

·    Orients, trains, and assists more junior level Representatives, and collaborates with other departments on group set ups, providing assistance as needed.

·    Analyzes deficiencies in processes/procedures and recommends improvements to management and implements with management approval.

·    Performs other duties as assigned.

Qualifications

Membership Billing Representative I - TPA

Education and Experience:

·    Associate's Degree in Business Administration, Communications or related field, or equivalent combination of training and experience.

·   1 year support experience in benefits administration, human resources or the insurance industry, preferably in health Insurance.

Professional Certification(s):

·    Health Care field certification a plus (i.e. medical terminology, certified coder/biller, etc.)

Technical Skills and Knowledge:

·    Basic knowledge of health insurance products and medical terminology.

·    Basic Microsoft Office skills.

·    Good math skills.

·    Ability to interact in a professional manner with customers via phone.

·    Solid data entry skills.

Membership Billing Representative II - TPA

Education and Experience:

·   Associate's Degree in Business Administration, Communications or related field, or equivalent combination of training and experience.

·   1 year as a Membership/Billing Representative or equivalent experience in health insurance membership and/or billing, preferably in a third-party administration environment.

Professional Certification(s):

·    Health Care field certification a plus (i.e., medical terminology, certified coder/biller, etc.)

Technical Skills and Knowledge:

·    Knowledge of health insurance products, medical terminology premium ratings and eligibility administration.

·    Intermediate proficiency with Microsoft Office and health insurance operations systems.

·    Strong math skills.

·    Ability to interact in a professional manner with customers via phone.

·    Solid data entry skills.

Sr. Membership Billing Representative - TPA

Education and Experience:

·   Bachelors' Degree in Business Administration, Communications or related field preferred, but will consider collective experience, training and education.

·    3 years' experience as a Membership/Billing Representative or equivalent experience in health insurance membership and/or billing, preferably in a third-party administration environment.

Professional Certification(s):

·     Health Care field certification a plus (i.e., medical terminology, certified coder/biller, etc.)

Technical Skills and Knowledge:

·     Knowledge of health insurance products, medical terminology premium ratings and eligibility administration.

·     Intermediate proficiency with Microsoft Office and health insurance operations systems.

·     Strong math skills.

·     Ability to interact in a professional manner with customers via phone.

·     Solid data entry skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.