Policy Admin Specialist (Dallas, TX)

| Dallas-Fort Worth, TX
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Job Summary
Organizes, maintains, and updates information to ensure members' enrollment and financial premium are current, per employee benefit plan policy. Works on conflicts and rejects related to members' data provided. Handles inbound customer calls from both client and members. Collaborates with the client benefits team to assist with member questions or tasks related to plan policy administration through both verbal and written communication. This position interacts with strategic/key clients which requires providing a specialized and complex service.

Essential Functions
  • The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Enrollment Responsibilities:

    . Processes enrollment updates, changes, adds and terminations either electronically or manually

    . Applying premium billing rates and refunds to members' accounts and successfully resolving discrepancy dollars

    . Handles client questions and requests regarding eligibility and member premium

    . Handles eligibility reports and audits, including daily Financial audits (40%)
  • Financial Responsibilities:

    . Provides designated team daily client billing report to validate release of NACHA files to the client's bank account.

    . Identifies client premium refunds due and prepares refund documentation for processing and payment approval.

    . Handles manual list billing by posting and applying payments.

    . Reconciles client's bank transactions for premium contributions monthly.

    . Reconciles client's bank transactions for claim payments.

    . Organizes and submit invoices to Finance Payments

    . Runs monthly financial reporting for reconciliation.

    . Processes NACHA file deletions, reversals, and returns.

    . Provides requested data for annual audit. (40%)
  • Customer Service Responsibilities:

    . Answer questions from the client's benefit team and members about enrollment and premium, while ensuring communication always remains courteous and respectful

    . Maintain a high accuracy level by providing complete and accurate information at all times

    . Document notes of each call to ensure all information is saved correctly

    . Abide by all Customer Service Goals as set by the Manager of the department

    . Maintains a positive relationship with the client benefits team (20%)

Required Work Experience
5+ years related work experience. Experience Details: in Enrollment, Customer Service, Financial, Claims Processing, or other related Health Insurance Administration experience

Required Management Experience
No supervisory/management experience required

Required Education
High school diploma or GED

Additional Required Qualifications
-Detail oriented-Ability to work independently/autonomously and proactively as well as collaboratively as a member of a team. -Must be a self-starter with the ability to identify problems/issues and offer workable solutions.-Ability to prioritize or seek information on how to best prioritize projects.-Project confidence, high energy, enthusiasm, and high regard for client advocacy and service.COMMUNICATION SKILLS-Strong verbal and written communication skills; ability to tailor communications based on audience and business objectives. -Comfortable working and communicating across operational areas and working in cross-functional teams-Maintain confidentiality and observe HIPAA and PHI requirements-Ability to effectively communicate with clients and executives in a confident manner.

Preferred Education
Bachelor's degree in a related field

Additional Preferred Qualifications
- work experience with employee health plan policy administration - Experience working with DataPath Summit or other premium billing processing software

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.
More Information on GuideWell
GuideWell operates in the Healthtech industry. The company is located in Jacksonville, FL. GuideWell was founded in 2014. It has 200 total employees. It offers perks and benefits such as 401(K), Remote Work Program. To see all 50 open jobs at GuideWell, click here.
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