Membership Representative

Jobtailor; Town of Florida (NY); On-site; USD 42,000 - 56,000; Full time

Job summary

Jobtailor in New York seeks an Enrollment and Billing Specialist to support plan members, providers, and employer groups. You will verify enrollment status, resolve system rejections, and educate callers to ensure accurate records.

The role requires a high school diploma or GED, strong customer service experience, and proficiency with enrollment databases. You will maintain billing accuracy, process premium payments, and coordinate with underwriting and sales as needed.

Qualifications

• HS diploma or GED with related experience or equivalent background.
• Membership experience or strong customer service background preferred.
• Experience with enrollment processes and billing management.

Responsibilities

• Responds to inquiries from plan members, providers and employer groups by answering benefit questions and educating callers.
• Verifies enrollment status and makes changes to records; researches and resolves enrollment system rejections.
• May handle billing and delinquency processes for assigned groups.
• Ensures accuracy and timeliness of the membership and billing function.
• Responds to inquiries concerning enrollment processes.
• Maintains enrollment database and may order identification cards.
• Determines eligibility and applies contract language for each case.
• Performs error output resolution for electronic eligibility and processes error lists.
• Bills, collects premiums and reconciles payments.
• Maintains and reconciles premium bill, self-bill and individual billed accounts.
• Notifies clients of premium discrepancies with notices and audits.
• Screens forms/data for new group or re-class of existing group; requests missing information.
• May load rates to new groups and renewal/re-class groups; screens group for benefits.
• Develops and maintains positive customer relations and coordinates with various functions to handle requests in a timely manner.

Skills

Customer Service

Enrollment Management

Billing Reconciliation

Data Accuracy

Issue Resolution

Communication

Problem-Solving

Customer Relations

Attention to Detail

Education

HS diploma or GED

Tools

Enrollment Database

Billing Software

Records System

Job description

Responsibilities

• Responds to incoming calls and may initiate outgoing calls, providing customer service to plan members, providers and employer groups by answering benefit questions, resolving issues and educating callers.
• Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections; addresses a variety of enrollment questions and/or concerns received by phone or mail.
• May be responsible for billing and delinquency processes for assigned groups.
• Ensures accuracy and timeliness of the membership and billing function.
• Responds to inquiries concerning enrollment processes.
• Maintains enrollment database.
• May order identification cards.
• Determines eligibility and applies contract language for each case assigned.
• Performs error output resolution for electronic eligibility and processes error discrepancy list.
• Bills, collects premiums and reconciles payments.
• Maintains and reconciles premium bill, self-bill and individual billed accounts.
• Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.
• Screens all forms and data for all paperwork received from Sales and/or Underwriting for new group and/or group re-classing benefits.
• Makes request to Underwriting, Sales or Brokers for missing information and/or forms needed for new group or re-class of existing group.
• May be responsible for loading rates to new groups and renewal/re-class groups within the appropriate system.
• Screens group for benefits to determine if existing or new, recognizing when benefits are not standard and handling as appropriate.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Requirements

• Requires an HS diploma or GED and related experience; or any combination of education and experience which would provide an equivalent background.
• Membership experience or a strong customer service background strongly preferred.

Core Competencies

Demonstrates expertise in customer service, enrollment processes, and billing management, ensuring accuracy and timeliness in handling member inquiries and account reconciliations. Proficient in maintaining enrollment databases and resolving discrepancies to support positive customer relations.

Highest-signal resume keywords

• Customer Service
• Enrollment Management
• Billing Reconciliation
• Data Accuracy
• Issue Resolution

Hard Skills

• Enrollment Verification
• Billing Processes
• Error Resolution
• Premium CollectionDatabase Maintenance

Soft Skills

• Communication
• Problem-Solving
• Customer Relations
• Attention to Detail

Industry Keywords

• Membership Experience
• Eligibility Determination
• Contract Language
• Payment Adjustments
• Audit Processes