Group Processing Specialist II

Job not on LinkedIn

🔥 3 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $35.5k - $56.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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PACIFICSOURCE

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

Not-for-profit health plans

📋 Description

• Process new group materials, change requests, member applications, and renewals for small and large fully insured groups, self-funded groups, and student health plans • Coordinate and confirm custom benefits and eligibility variations • Coordinate with teams to review and create new products or plan materials • Attend new and renewing large group implementation meetings and identify customization, testing needs, and deliverable timelines • Review applications, renewal forms, proposal requests, and correspondence; follow up on missing information • Analyze group structure, billing, and reporting requirements • Enter group data into the Online Enrollment System and Online Waiver System • Validate product, financial, and related codes for groups and subgroups • Coordinate with the Facets Business Support team on new product implementations • Create and distribute plan materials • Process group demographic changes • Generate censuses and cross-reference member information • Process final premium rates for new enrollments and renewals • Coordinate with Actuarial and Underwriting teams • Track processing status and maintain group notes • Verify appointed producers and enter data into the appropriate system • Perform QA testing of new processes or Facets updates • Assist with Commercial Individual and Government product line group configurations • Update and maintain the team escalation board • Develop and update procedures, job aids, and lessons • Maintain accuracy standards for department, CMS, and PacificSource PRISM measures • Attend scheduled meetings and mentor lessons • Perform other assigned duties

🎯 Requirements

• Minimum of 2 years of related medical insurance or healthcare-related experience required • High school diploma or equivalent required • Excellent verbal and written communication • Basic Excel proficiency • Strong typing skills • Effective problem-solving skills • Ability to proficiently interpret state and federal insurance regulations • Ability to maintain knowledge of PacificSource procedures, policies, products, and contracts • Meet department and company performance and attendance expectations • Follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information • Ability to read and comprehend both written and spoken English • Ability to communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing motions, and lift and carry files and business materials

🏖️ Benefits

• Full-time employment • Work from home arrangement in Florida • Equal opportunity employment • Ergonomically configured equipment • Team, department, and company meetings and mentor lessons • Travel required less than 5% of the time