The Role
Serve as in-office service contact for assigned employer groups handling enrollment, billing, claims, delinquency, retro transactions, pre-enrollment, contracting, onboarding, and open enrollment. Coordinate with cross-functional teams, meet retention and service metrics, and support strategic account activities and documentation updates in QNXT.
Summary Generated by Built In
Job Summary & Responsibilities
- Be the in-office service contact for assigned groups. Resolves day-to-day servicing inquiries directly with account contact via e-mail and phone for enrollment, billing and claims inquiries. This requires knowledge about benefits for medical, drug and dental lines of business, claims processing knowledge to work with Customer Relations and BlueCard, and enrollment and billing knowledge to work with Membership Services and Finance and Accounting. It requires the ability to think through a complex issue, collaborate with others, and make independent decisions to find a satisfactory resolution to the issue in a short timeframe in order to meet customer expectations. Additionally, the ARS must possess excellent communication skills and a customer focused approach to explain potential complex issues to Employer Group Leaders.
- Screen delinquency report monthly and proactively reach out to employers who are past due, or request exceptions when justified. Follow up with actions to avoid negative impact on the group's employees.
- Review retroactive transactions and decide whether an exception is warranted. Research claims paid and uncovered any special circumstances which may affect exception decision.
- Act as the call center for pre-enrollment activities for special strategic accounts such as EUTF, CVS, Aon Exchange, and other select groups. This requires benefit knowledge for the various lines of business as well as a thorough understanding of member co-pays, co-insurance, maximum out of pocket, deductibles, etc.
- Support groups through the group contracting process. Prepare and submit documentation of accepted renewal rates and benefit changes (if applicable) for system updates. Verify that rates and benefits submitted are reflected accurately in HMSA's QNXT system. Coordinate Guide to Benefits and certificate requests. Validate the Summary of Benefits Coverage (SBCs), Benefit Summaries, and Summary of Changes that all accurately reflect what the group contracted for. Ensure that employer group SBCs are sent out timely in accordance with Federal regulations.
- Coordinate activities associated with Open Enrollment and the new group on-boarding process as assigned.
- Meet assigned goals for customer retention, servicing standards, customer survey and other key performance metrics as defined.
- Work in collaboration with cross functional team consisting of Strategic Account SAM, ARC, and HPA. This includes contributing to team meetings in strategic account planning, escalating issues appropriately, accepting delegated work from members of the team, and serving as the in-office contact for field-based team members needing assistance while in the field.
- Assist in developing and implementing proactive sales and servicing strategies
- Back up other ASR team members and account teams.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
Preferred Qualifications- Bachelor's degree and one year of related work experience, or equivalent combination of education and/or related work experience.
- Strong verbal and written communication skills.
- Intermediate working knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.
Top Skills
Bluecard
Excel
Microsoft Outlook
Microsoft Powerpoint
Microsoft Word
Qnxt
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The Company
What We Do
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage. We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
