Group Processing Specialist II

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Essential Responsibilities:

• Process new group materials, change requests, member applications, and renewals for small and large fully insured groups, self-funded groups, and student health plans.
• Coordinate and confirm custom benefits and eligibility variations as required.
• Coordinate with teams to review and create new products or plan materials, as needed.
• Attend new and renewing large group implementation meetings. Identify customization, testing needs, and timelines for deliverables.
• Review group master applications, renewal confirmation forms, proposal requests, and various other forms or correspondence received. Follow up with internal teams for missing information.
• Analyze new and renewing group structure, billing, and reporting requirements.
• Enter group data into various applications including the Online Enrollment System and the Online Waiver System.
• Validate product codes, financial codes, and other related codes for groups and subgroups.
• Coordinate with Facets Business Support team for new product implementations as needed.
• Create and distribute plan materials accurately and timely.
• Process all group demographic changes.
• Generate census and cross-reference member information on master application with final proposal census.
• Process final premium rates for new group enrollments and group renewals.
• Coordinate with Actuarial and Underwriting teams as needed.
• Track group processing status and maintain group notes.
• Verify appointed producer and enter data into the appropriate system.
• Provide essential QA testing of new processes or updates in Facets and other systems as needed.
• Assist with Commercial Individual and Government product line group configurations, as necessary.
• Update and maintain the team escalation board.
• Develop and update procedures, job aids, and lessons as needed.

Supporting Responsibilities:

• Maintain accuracy standards as required to meet department, CMS and PacificSource PRISM measures.
• Meet department and company performance and attendance expectations.
• Attend team, department, company meetings, and mentor lessons as scheduled.
• 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 of 2 years of related medical insurance or healthcare-related experience required.

Education, Certificates, Licenses: High school diploma or equivalent required.

Knowledge: Excellent verbal and written communication, basic Excel proficiency, strong typing, and effective problem-solving skills. The ability to proficiently interpret state and federal insurance regulations and maintain knowledge of PacificSource procedures, policies, products, and contracts.

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:

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range:

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.