Enrollment Reconciliation Specialist
YHI is seeking an enrollment reconciliation specialist who can provide support on a wide range of complex customer support services to include responsibility for customer support escalations, complex case management, and reconciliation of enrollment records. The Reconciliation team will include experienced individuals who primarily provide support for escalated or complex situations.
Responsibilities (Position may include additional functions not listed)
- Provide thorough, timely, and accurate resolution of carrier reconciliation disputes and escalated complex cases via telephone, email, and other methods in partnership with a high-volume call center to include peak workloads during annual open enrollment periods. Consistent attendance is an essential requirement for Reconciliation Specialists in order to perform job expectations in YHI’s high-volume call center environment.
- Accurately research and resolve data discrepancies to ensure data integrity across external partners.
- Analyze data, identify trends, technical issues, and comparison issues.
- Support wide range of consumer questions such as general insurance enrollment, non-financial assistance eligibility, making enrollment changes, use of the online technology, individual enrollment, plan selection alternatives, family status changes, and other insurance and/or ACA related topics.
- Support wide range of questions from Carriers, Agents/Brokers, and other stakeholders. May also answer consumer questions about IPA, Navigators, and CACs as well as supporting Agent/Broker Portal questions.
- Respond professionally and appropriately to inbound calls and other sources of consumer contact. Manage difficult or emotional consumer situations and respond promptly to consumer inquiries.
- Complete accurate data entry of contact with consumers in YHI’s computer systems.
- Utilize YHI’s technology platform to review relevant consumer information and resolve consumer concerns or questions.
- Conduct research as necessary to effectively resolve complex consumer situations.
- Adhere to YHI policies, procedures, and expectations in order to meet YHI performance objectives in service, quality assurance, and productivity.
- Support YHI’s carrier appeals process, carrier reconciliations, and renewal of eligibility for non-financial assistance. Support YHI’s processing of non-financial eligibility renewals and appeals.
- May create, route, and respond to consumer and/or agent/broker tickets.
- Support YHI’s consumer support system, which may include case management, escalations, appeals and grievances.
- Perform other duties as assigned.
Qualifications (Required knowledge, skills, abilities, education, experience, etc.)
- Associates degree preferred or equivalent through professional experience
- 1-year customer service experience, including resolving complex customer issues
- Ability to troubleshoot both technical and non-technical issues
- Excellent verbal and written communication skills, including strong interpersonal telephone skills
- Ability to effectively listen and elicit information
- Strong computer skills, including Microsoft Office and ability to learn/utilize other technology applications
- Ability to navigate multiple computer systems, applications, and utilize search tools to find information
- Strong problem solving, reading comprehension, and troubleshooting skills
- Ability to sit and/or stand at a desk and work with a computer for extended periods of time
- Knowledge of the Affordable Care Act (ACA) preferred
- Ability to work in a fast-paced workplace, adapt to a continually evolving environment
- A committed team player with exceptional interpersonal, problem-solving, and communication skills with ability to develop and maintain cooperative and productive work relationships
- Ability to assume responsibility and maintain confidentiality consistent with the values and integrity of YHI
Physical & Other Requirements
- Ability to work in an office environment, primarily sedentary.
- Consistent attendance is required, including full-time during initial three-week training session (8 hours/day, 5 days/week) as well as regularly scheduled shifts thereafter.
- Ability to listen to and understand others as well as ability to give and receive instructions via telephone, computer messages, face-to-face, and in writing
- Ability to operate computer and software applications; use of normal office machines
- Availability to work additional hours or weekends based on call center demands
Equal Opportunity Employer
Responsibilities and qualifications listed are not all inclusive.
We know that choosing a health plan can be complicated and Your Health Idaho is here to help with the tools and resources you need including information about the premium tax credit and reduced cost-sharing. Consumer Connectors, including agents, brokers and Enrollment Counselors, are here to help you understand your options at no cost to you.