100% Remote - Reconciliation Representative

100% Remote ( Local Candidates preferred)

Purpose of Position:

The Reconciliation Rep I will be responsible for reviewing and researching reconciliation items submitted by Choice Administrators’ carriers, including Health Equity for COBRA. The Reconciliation Rep I will provide quality and efficient service to carriers and resolve discrepancies between Choice Administrators’ and carrier partners through the daily reconciliations tasks. Additionally, this role will assist the immediate supervisor with the development, analysis, and implementation of continuous process improvement, interdepartmental communication, training, and other related duties as assigned.

Essential Functions:

• Complete carrier reconciliation reports by researching to confirm eligibility info/payments were made based on the group/member demographics. Will work with other departments within Choice Administrators (i.e. Finance, IT) to ensure the integrity of system data
• Submit timely responses to the carriers on audits and other inquiries.
• Perform regular Quality Checks on items processed, track and report processing errors found
• Provide continual evaluation of processes/procedures and assist in creating process improvements
• Adhere to all PHI (Personal Health Information) and HIPAA (Health Insurance Portability and Accountability Act) guidelines
• Gather information needed for Customer Service to submit appeals and collaborate with management on carrier related issues
• Assist with generating manual checks/negative voucher requests, follow-up on approval status with management and communicate progress with carriers as needed
• Assist in submitting requests for IT tickets when reconciliation errors result from system issues as needed
• Assist with system/user testing of all applicable systems as needed
• Keep management/team informed about problems and recommend and implement solutions
• Assist in updating and/or submitting requests for new reports with all applicable data (i.e. system/user errors, etc.)
• Propose system enhancements to improve efficiency based on reconciliations and error findings
• Provide statistical and performance feedback to management regarding performance as requested
• Assist in establishing goals, standards and objectives for carrier reconciliations
• Assist with creating and revising processing guidelines, instruction files and workflows on SharePoint
• Assist with training as needed and applicable
• Meet department/team standards for quality/quantity of work based on established turnaround times for processing
• On-site or remote regular attendance and punctuality are essential functions of the job
• Perform other business tasks or functions as assigned.

Knowledge, Skills & Abilities Required:

• Must have the ability to handle objections and explain company policy to our carriers
• Must be self-guided, with the ability to follow directions and work with little supervision. Highly motivated and able to take initiative
• Great communication skills, (written, grammatical, verbal, developmental)
• Ability to collaborate and communicate effectively with all levels of executives, management, employees, and carrier partners
• Ability to organize and plan work with a track/record for meeting deadlines
• Excellent customer service skills
• Ability to work well in a fast-paced professional office environment
• Proficient with Microsoft Office software (Word, Excel, PowerPoint, Visio, Publisher, SharePoint, Outlook)
• Strong background using data management systems
• Ability to learn quickly and retain large quantities of information regarding department and company policies
• Must be able to prioritize, manage time well, and handle multiple tasks at one time
• Strong problem solving and critical thinking skills in a cross-functional environment
• Strong mathematical and analytical skills
• Must be detail-oriented with exceptional organizational skills
• Experience researching and resolving complex billing issues
• Demonstrated proficiency with Microsoft Excel, Word, Visio, SharePoint, Outlook
• Ability to take initiative and be resourceful
• Proficient use of 10 Key
• Prior experience in the Health Insurance industry preferred

Educational Requirements:

• High School Diploma or equivalent required
• Preferred graduation from an accredited four-year college or university; or a level of education that, together with experience and training, enables the applicant to demonstrate the required knowledge and experience.

Physical Requirements:
Must be able to sit for extended periods of time and occasional standing and walking. Must have adequate hearing for phone work. Vision requirements include close vision and the ability to adjust focus. Must be able to communicate effectively in English. Must be able to use a keyboard and other office equipment. Ability to lift up to 30 pounds occasionally.

Job Type: Full-time

Pay: $20.00 - $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Vision insurance
• Work from home

Work Location: Remote