POSITION RESPONSIBILITIES
- Review and reconcile client eligibility and payments.
- Determines active, retiree, and COBRA eligibility based on plan sponsor plan provisions.
- Processes enrollment eligibility files and completes enrollment edits in system queues.
- Enter new employees and dependents into the system and make changes to existing records as required.
- Ensure identification cards are ordered correctly and timely according to plan sponsor and company guidelines.
- Post & reconcile client payments.
- Process vendor disbursements and reconciles payments according to vendor requirements and company guidelines.
- Disburse end-of-the-month reports to clients as required.
- Completes the review of and responds to vendor discrepancy reports as assigned.
- Interprets and communicates COBRA and HIPAA regulations.
- Handles self-pay administration according to plan provisions and guidelines.
- Answers email and call inquiries from participants, clients, vendors and local unions.
- Provides customer service and maintains effective relationships with clients, participants, agents, and brokers.
- Update and maintain Client Policy and Procedure document.
- Adheres to and is responsible for the understanding of company eligibility policies and procedures and resources.
- Meets department production and quality metrics.
- Participates in and contributes to mandatory department meetings, training, and company events.
- Completes company, department, or plan sponsor special projects.
- Follows company attendance policy and adheres to provisions in the collective bargaining agreement.
- Upholds and exemplifies company values.
- Performs other duties as assigned.
- Review and process all internal and client specific weekly and/or monthly reports.
- Email and Group folder organization.
This position is customer service oriented. It requires the ability to effectively communicate with HR staff at client groups, in addition to other external and internal customers; can prioritize assignments/tasks; work steadily, accurately and thoroughly; successfully meet assigned deadlines; evaluating and decision-making skills; reconciliation skills.
Education/Experience- Completion of High School or equivalent, including or supplemented by a course in bookkeeping, accounting or related. AA degree preferred.
- Minimum 6 months in customer service with bookkeeping or accounting experience.
- Can operate a 10-key adding machine.
- Must possess good oral and written communication skills along with strong basic mathematical skills.
- Proficient in Microsoft Applications and computer literacy.
Skills Required
- High school diploma or equivalent
- Associate (AA) degree
- Minimum 6 months customer service with bookkeeping or accounting experience
- Ability to operate a 10-key adding machine
- Proficient in Microsoft Applications
- Computer literacy
- Good oral and written communication skills
- Strong basic mathematical skills
- Ability to interpret and communicate COBRA and HIPAA regulations
- Reconciliation skills and experience posting/reconciling payments
- Customer service skills; ability to communicate with HR staff, clients, vendors and unions
- Ability to prioritize tasks, meet deadlines, and maintain accuracy
- Ability to update and maintain client policy and procedure documentation
What We Do
WM Michael Stemler, Incorporated, doing business as Delta Health Systems (DHS), is a leading Third Party Administrator (TPA) for self-funded health plans. The company provides insurance services, specializing in medical insurance claim processing and the administration of flexible spending accounts (FSA), offering resources and an online FSA store to help members and providers manage healthcare spending effectively.

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