Eligibility and Member Services Specialist

pacificlife; Omaha (NE); On-site; USD 55,000 - 67,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Wellbeing reimbursement account

PTO and holidays

Financial planning time off

Paid parental leave

Job summary

Pacific Life in Omaha, NE is seeking an Eligibility & Member Services Specialist to join the Employer Services Team. You will audit and resolve discrepancies in member data, partner with brokers and employers, and deliver a friction-free experience in the Workforce Benefits Division.

You will work on a team of 15 and collaborate with Eligibility, Account Executives, and Billing professionals. Strong communication, analytics, and data-management skills are essential.

Qualifications

• College degree or equivalent experience preferred.
• 3-5 years of financial services, product compliance or group benefits operations experience.
• Effective communicator with external stakeholders.
• Customer-centric with problem-solving skillset.
• Detail-oriented with strong analytics.
• Demonstrated time management and organizational skills.
• Intermediate MS Office applications.

Responsibilities

• Research, problem-solve and remediate inforce client challenges related to member management.
• Identify root causes of discrepancies by researching plan design, rates, file feeds and comparing to Administration System and TPA data.
• Understand end-to-end impact of policy, rate and member-level changes to eligibility and billing.
• Update member-level data and coordinate file feeds to ensure system data accuracy.
• Leverage data from multiple sources and use formulas for large comparisons.
• Negotiate on due amounts with Underwriting, Billing and Distribution when needed.
• Consult with clients to resolve issues and provide transparent status updates.

Skills

Client communication

Analytical thinking

Attention to detail

Time management

Problem solving

Education

College degree or equivalent experience

Tools

Excel

EIS System

Job description

Job Description

Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead - our policyholders count on us to be there when it matters most. It's a big ask, but it's one that we have the power to deliver when we work together. We collaborate and innovate - pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it's the right thing to do. Pacific Life is more than a job, it's a career with purpose. It's a career where you have the support, balance, and resources to make a positive impact on the future - including your own.

We're actively seeking a talented Eligibility & Member Services Specialist to join our Employer Services Team in Omaha, NE.

As a Eligibility and Member Services Specialist, you'll move Pacific Life, and your career, forward by playing a key role in auditing and resolving discrepancies based on employer's product configuration & the member level data received while delivering a first-class friction free experience to our employers in the Workforce Benefits Division. You will fill a new role that sits on a team of 15 people in the Workforce Benefits Division. Your colleagues will include Eligibility, Account Executives and Billing professionals.

How you'll help move us forward

• Work independently with brokers and employers to research, problem-solve and remediate inforce client challenges related to member management.
• Identify root causes of complex member level discrepancies by researching plan design, rates, file feed data, kick outs and doing comparisons to Administration System and TPA information often arising during billing, renewals, amendments, and open enrollments.
• Understand end to end impact of policy, rate, & member level changes to eligibility and billing/premium with the ability to build a resolution plan to remediate.
• Identify needed changes to update member level data and coordinate along with file feeds to ensure system data is accurate.
• Leverage data from multiple sources and use tools and formulas to expediate large comparisons.
• Determine any back charges or credits that need reviewed for accuracy and can work with Underwriting, Billing and Distribution to discuss any needed negotiations on due amounts.
• Consult with clients and make decisions aligned with our organization operating model to ensure issues and/or requests are fully resolved.
• Build strong relationships with Sales/Distribution, Brokers and Employers as a trusted advisor within our Workforce Benefits Division.
• Coordinate, manage and lead conversations with Employers, Brokers and other partners to provide exceptional customer experience.
• Own issues to ensure timely resolution and escalates to management with recommendations on how to address unresolved service issues.
• Follow-up and provide transparent communications on the status of outstanding issues as needed.
• Understand the full Broker, Employer, and Employee journey to deliver elevated service in issue resolution.
• Work within departmental controls for all aspects of the role with a high standard of ethics.
• Strong knowledge of our product offering, system(s), and processes as well as understand how data flows throughout employer and employee journeys.
• Participate and contribute to team meetings or special tasks and assignments and brings innovative ideas and a continuous improvement mindset to the department.

The experience you bring

• College degree or equivalent experience preferred.
• 3-5 years of financial services, product compliance or group benefits operations experience
• Needs to be an effective communicator with externally facing presence.
• Customer-centric with problem-solving skillset
• Detail-oriented
• Strong analytical skills
• Demonstrated time management and organizational skills
• Intermediate skills with MS office applications

What makes you stand out

• Experience in Eligibility and Evidence of Insurability at a group carrier
• Prior work in EIS System
• Expert level experience in Excel
• #LI-AJ1

Base Pay Range

The base pay range noted represents the company's good faith minimum and maximum range for this role at the time of posting. The actual compensation offered to a candidate will be dependent upon several factors, including but not limited to experience, qualifications and geographic location. Also, most employees are eligible for additional incentive pay.

$26.31 - $32.15

Your Benefits Start Day 1

Your wellbeing is important to Pacific Life, and we're committed to providing you with flexible benefits that you can tailor to meet your needs. Whether you are focusing on your physical, financial, emotional, or social wellbeing, we've got you covered.

• Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents
• Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off
• Paid Parental Leave as well as