Bachelor's degree with five years of relevant experience or equivalent education and experience.
Two years of management or supervisory experience.
Strong knowledge of managed care frameworks including PPO, HMO, Medicaid, and Medicare Advantage.
Familiarity with claims adjudication systems such as Facets or Epic Tapestry.
Solid communication skills, both verbal and written.
Proficient in Microsoft Office tools, particularly Word, PowerPoint, Outlook, and Excel.
Responsibilities
Lead and mentor the membership admin team with a focus on training and best practices.
Oversee daily operations of the membership admin team, handling inventory analysis and issue resolution.
Act as the point of escalation for complex cases, ensuring timely resolutions within established SLAs.
Analyze KPIs to identify issues and implement improvements for heightened efficiency and customer satisfaction.
Collaborate with underwriting, legal, and service teams for streamlined case processing.
Ensure all documentation and reporting meets compliance and internal control standards.
Aid in developing and introducing new policies and systems to enhance membership administration.
Benefits
Comprehensive health and wellness programs.
Flexible work arrangements including hybrid options.
Opportunities for professional development and training.
Paid time off and holiday leave.
Retirement savings plans with company matching.
Full Job Description
Manage and lead a membership admin team by providing training, mentorship, and best practice solutions.
Manage daily operations of the membership admin team, including inventory analysis, tracking and resolution
Serve as the escalation point for complex or disputed cases and drive resolution within defined SLA.
Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction
Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely case processing.
Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements.
Contribute to the development and implementation of new policies, procedures, and systems to improve membership admin operations.
Stay current with changes in laws, regulations, and industry best practices related to membership admin management. Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
Two years of leadership, supervisory, or management experience.
In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans
Working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge)
Effective written and verbal communication skills
Intermediate working knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.
