Enrollment Resolution Specialist I

Capital District Physicians Health Plan Inc; Buffalo (NY); Hybrid; USD 44,000 - 74,000; Full time

Job summary

Capital District Physicians Health Plan Inc is seeking an Enrollment Resolution Examiner to resolve complex enrollment and billing issues across multiple operations. You will work under management guidance, ensuring regulatory compliance and accurate financial records.

The role requires 3+ years in financial data or health insurance enrollment, strong analytical and communication skills, and proficiency in Microsoft Office.

Qualifications

• Conducting financial analyses and recommendations, or related work experience and proven ability to exercise the requirements and responsibilities of the position required.
• Three (3) years' experience with financial data or Health Insurance Enrollment experience; or an associate degree in finance, accounting, or similar discipline.
• Capable of establishing constructive relationships with all levels of internal and external of the organization.
• Must be able to prioritize assignments and work accurately and independently within established time frames.
• Must be flexible and able to adjust to rapidly changing priorities.
• Must have solid communication skills - both verbal and written.
• Proven organizational, analytical, and time management skills.
• Computer proficiency, including experience in Microsoft Office Suite.
• Strong attention to detail and accuracy.

Responsibilities

• Responsible for reconciliation of regulatory and Health Plan Enrollment data through audit and review, utilizing internal and external guidelines/regulations/policies and procedures.
• Responsible for ensuring member and/or group documentation and transactional updates are completed to reconcile account discrepancies.
• Investigates, works, analyzes, tracks and monitors operational issues identified during the financial balancing adjustment of funds.
• Prepares regular and periodic reports for the review and assurance of following processing guidance including but not limited to the operations reporting of all transactions.
• Initiates necessary requests to other operational areas to resolve identified problems or recommendations for procedure changes based on analysis completed.
• Communicates with internal and external customers and provides supporting documentation and makes recommendations for procedure changes based on analysis completed.
• Maintains high regard for member privacy in accordance with corporate privacy policies and procedures.
• Be proficient in one line of business and able to process inventory from other lines of business as requested.

Skills

Financial analysis

Communication skills

Organizational skills

Time management

Microsoft Office

Education

Associate degree in finance or accounting

Tools

Microsoft Office Suite

Job description

Capital District Physicians Health Plan Inc is seeking an Enrollment Resolution Examiner to resolve complex enrollment and billing issues across multiple operations. You will work under management guidance, ensuring regulatory compliance and accurate financial records.

The role requires 3+ years in financial data or health insurance enrollment, strong analytical and communication skills, and proficiency in Microsoft Office.