Specialty Billing Representative I

Blue Cross Blue Shield of Michigan; Lansing (MI); On-site; USD 52,000 - 78,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking a Level I/II Specialty Billing Representative to manage manual billing, commissions, and retrospective premium adjustments for Enterprise brands. The role involves working with policyholders, agencies, and external collectors to resolve delinquencies and maintain accurate account histories.

Responsibilities include monitoring collateral, processing pay-by-phone transactions, and contributing to system development and data accuracy across multiple

Qualifications

• Minimum of an Associates degree in Business or equivalent; combos allowed.
• Minimum of three (3) years experience in billing, underwriting, policy processing or equivalent.
• Level II requires five (5) years experience or a Bachelor’s degree with three years of relevant experience.

Responsibilities

• Maintains knowledge of policy and commission structure for each brand.
• Performs manual commission calculations and issues statements monthly.
• Bills retrospective premium adjustments and monthly losses for loss-sensitive business.
• Monitors collateral to ensure proper funding.
• Works with policyholders and external agencies on past due balances.

Skills

Billing operations

Analysis

Data interpretation

Multi-tasking

Communication

Education

Associates degree in Business

Bachelor's degree in Business (optional)

Tools

Billing systems

Spreadsheet software

Policy processing systems

Job description

SUMMARY

Level I is in a learning capacity and will progress to the senior level when the incumbent qualifies and is able to provide coverage and assistance across all primary responsibilities and focus areas independently.

This job is primarily responsible for products and services underwritten by the Enterprise that require manual processes due to the complex nature of the request or system limitations. Performs in-house collection activity that ultimately determines financial resolution of delinquent funds owed to the Enterprise. Services, bills and manages tasks related to "specialty" (i.e. Loss Sensitive, AccuPremium) business underwritten by the Enterprise. Calculates commission owed to agencies on a monthly basis and handles all servicing related to agency commissions. Contacts include: Enterprise employees, agents and policyholders, external collection agencies, NCCI and legal representatives.

PRIMARY RESPONSIBILITIES

• Maintains in-depth knowledge of policy and commission structure of each brand within the Enterprise.
• Completes manual commission calculations for the individual brands within the Enterprise. Creates statements and check requests to pay commissions on a monthly basis.
• Manually calculates and bills for retrospective premium adjustments and monthly losses related to loss sensitive business for all brands within the Enterprise.
• Monitors and tracks collateral to ensure loss funds are adequately funded.
• Works directly with policyholders and external collection agencies in regards to past due balances. Uses authority levels to make decisions in regards to balances due.
• Monitors aging reports and completes follow-ups with Premium Audit, Underwriting and Management.
• Reviews, negotiates and approves payment arrangements and settlement offers on past due receivables for the Enterprise.
• Files bankruptcy claims with the Bankruptcy Court for policyholders that have entered bankruptcy. Has an understanding of the different types of bankruptcy and how to appropriately handle each.
• Participates in the development of requirements related to new Enterprisewide systems.
• Verifies reasonableness of data in ancillary and disparate systems.
• Reconciles accounts to clarify billing transactions and cash application in order to provide customers with up-to-date account information/history.
• Responds to internal and external customer requests via telephone or electronic correspondence. Correspondence is drafted as requested to address complaints or information requests. Requests are initiated by agents, policyholders, underwriters, or management.
• Processes pay by phone transactions to expedite posting of cash to insured's policy.

ADDITIONAL RESPONSIBILITIES FOR THE LEVEL II

• Provides coverage and assistance across all primary responsibilities and focus areas.
• Provides training and mentoring to the Level 1 Specialty Billing Representative position.
• Addresses and responds to complex internal and external customer requests.
• Works with minimum supervision.

EMPLOYMENT QUALIFICATIONS

A. EDUCATION REQUIRED: (Brief paragraph detailing the minimum education required, including certifications) Do not state preferred qualifications.

Minimum of an Associates degree in Business or equivalent. Combinations of relevant education and work experience may be considered in lieu of degree.

B. EXPERIENCE REQUIRED:

Minimum of three (3) years experience in billing, underwriting, policy processing or equivalent work which provides the necessary skills, knowledge and abilities.

OR

Bachelor's degree in Business or equivalent and 1 year of relevant experience in billing, underwriting or policy processing. Combinations of relevant education and work experience may be considered in lieu of degree.

ADDITIONAL EXPERIENCE REQUIRED FOR THE LEVEL II:

Minimum of five (5) years experience in billing, underwriting, policy processing or equivalent work which provides the necessary skills, knowledge and abilities.

OR

Bachelor's degree in Business and 3 years of relevant experience in billing, underwriting or policy processing.

C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED

• Basic knowledge of workers compensation.
• Knowledge of claims and underwriting operations (i.e. deductibles, billing etc.,)/
• Ability to analyze details of policy billing and payment data and, based on this analysis, make efficient and effective independent decisions within authority.
• Ability to analyze details of policy billing and payment data and, based on this analysis, make efficient and effective independent decisions within authority.
• Ability to manage multiple priorities and meet established deadlines.
• Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.
• Knowledge of insurance operations. Specifically as they pertain to state specific requirements.
• Excellent math skills. Ability to accurately interpret and analyze data.
• Ability to process transactions on multiple processing systems.
• Ability to use diplomacy, discretion and appropriate judgment when addressing callers.
• Requests write offs to resolve small balance and NSF fee discrepancies within guidelines.
• Requests money moves to ensure accurate posting of cash.
• Maintains knowledge of state regulations as they pertain to movement of funds between policies and legal entities.
• Maintains confidentiality of information processed
• Re-allocatable to Level II
• Ability to proofread documents for accuracy of calculations.
• Excellent organizational skills and ability to prioritize work in order to meet strict deadlines.
• Excellent oral and written communication skills.
• Excellent analytical and problem solving skills.
• Knowledge of computers and ability to type 40 words per minute.
• Knowledge of word processing software.
• Basic knowledge of database software.
• Advanced knowledge of spreadsheet software.
• Ability to effectively exchange information clearly and concisely, reports facts and other information and respond to questions as appropriate.
• Knowledge of policy and claim processing systems.

ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED for the LEVEL II

• Knowledge of enterprise policy and commission structure.
• In-depth understanding of collateral structures and plans.
• Ability to interpret, analyze and bill a policy with minimal supervision.
• Knowledge of state specific collection regulations and laws.
• Knowledge of loss sensitive plans used by the enterprise; specifically, how balances related to losses are calculated and invoiced.
• Knowledge and understanding of both underwriting and claims is obtained
• In-depth knowledge of insurance operations. Specifically as they pertain to state specific requirements.
• Demonstrated knowledge to provide coverage and assistance across all primary responsibilities referenced above.
• Ability to make decisions and work with minimal supervision.
• Ability to manage multiple priorities and meet established deadlines.

D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED

• Bachelor's degree in Business
• Insurance education coursework.
• Knowledge of departmental procedures, workflows, and systems.
• Knowledge and experience of policy processing, claim and financial reporting systems.

WORKING CONDITIONS

Work is performed in an office setting with no unusual hazards.

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