Group Processing Specialist I
PacificSource

Job Info

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Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Process new standard small groups, renewals, and change requests, by entering data in multiple system applications. Generate plan materials and ID cards, meeting entry timelines and accuracy requirements. Ensure compliance with policies, procedures, and applicable laws and regulations.

Essential Responsibilities:

• Review and prepare new group materials, group change requests, new group member applications, and renewal changes for small fully insured groups, for imaging in OnBase application.
• Coordinate and confirm benefits and eligibility variations on groups as required. Coordinate with staff to analyze and create new products or plan materials, as needed.
• Review group master applications and/or renewal confirmation forms, other applicable forms, proposal requests, and correspondence. Follow up with Sales staff for missing information.
• Analyze new and/or renewing group structure, billing, and reporting requirements. Enter group data into Facets and PSE.
• Validate product codes, financial codes, and other related codes for groups and subgroups. Determine if new product is needed to support rating and coordinate with the Facets Business Support Department as needed.
• Create and distribute plan materials in accordance with current workflow processes.
• Process all group demographic changes.
• Generate census and cross-reference member information on master application with final proposal census.
• Upload final premium rates based on actual enrollment for new groups, or rates calculated at renewal. Follow-up with Actuarial and Underwriting team as needed.
• Track group processing status in PSE and enter group notes in Facets.
• Verify appointed producer and enter data in Facets.
• Develop and update procedures, job aids, and lessons as needed.
• Provide essential QA testing of new processes or updates in Facets, OnBase and PSE.
• Update and maintain the team escalation and/or idea board.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Participate in Escalation Board daily huddle, team and department meetings, mentor training, and team building activities.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum one year of related experience in the health care industry required. Strong keyboarding and Excel experience required.

Education, Certificates, Licenses: Requires high school diploma or equivalent. Prefer Associate's Degree in business or healthcare, or equivalent work experience.

Knowledge: Ability to understand and interpret state and federal insurance laws. Remain current on PacificSource procedures, policies, products, and contracts. Excellent verbal, telephone and written communication skills.

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.

Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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