Business
Data Entry Specialist
Job ID: #
Purpose: Assist client with Billing and Enrollment issues for their Marketplace program.
Position Definition: Work through adverse scenarios impacting a member's enrollment status in their Marketplace policy.
Apply premiums paid by members on their Marketplace policy.
Company:
Location:
US - Remote
Company Size:
Job Type:
Full Time
Date:
Non-Phone
Requirements
Position Characteristics: Compile records, and evaluate personal and financial data. Keep records of assigned cases and prepare reports.
Essential Duties and Responsibilities (include but are not limited to): Processes daily enrollee invoices and premium reconciliation for members · Reconciles unallocated payments, monies, and premiums received from the individual subscriber or responsible party with the amount due for the healthcare program the member is enrolled in.
Resolves invoice discrepancies prior to monthly report run.
Performs month-end invoicing and accuracy audits. Resolve eligibility issues affecting premium billing. Generates reports and billing data using the premium billing module to be sent to print and fulfillment vendor.
Reconciles eligibility data to ensure that the member data loaded in system matches the file (exception report).
Works PCP exception report - assigns member to PCP.
Works pharmacy exception report - validates eligibility updating system and website.
Works vision exception report - validates eligibility and updates system.
Works ID card exception report - validates member demographic information updating system accordingly and regenerates ID card as needed.
Complete member moves – reassigning member from one PCP to another.
Works monthly eligibility reconciliation (audit file/baseline vs. system) – updates eligibility data in system accordingly.
Confirms monthly reporting. Validates eligibility by updating system accordingly using premium file details.
Knowledge, Skills and Abilities: Any combination of education, experience, and training that would likely provide the required knowledge and abilities in qualifying.
We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.