Group Processing Specialist II

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🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $35.5k - $56.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 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; 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 • Coordinate with the Facets Business Support team for new product implementations • Create and distribute plan materials • Process group demographic changes • Generate census and cross-reference member information with final proposal census • Process final premium rates for new enrollments and renewals • Coordinate with Actuarial and Underwriting teams • Track group processing status and maintain group notes • Verify appointed producers and enter data into the appropriate system • Perform QA testing of new processes or updates in Facets and other systems • 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 • Attend scheduled meetings and mentor lessons • Perform other duties as assigned

🎯 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 • Effective problem-solving skills • Ability to proficiently interpret state and federal insurance regulations • Ability to maintain knowledge of PacificSource procedures, policies, products, and contracts • Maintain accuracy standards required to meet department, CMS and PacificSource PRISM measures • 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/carry files and business materials • Travel required approximately less than 5% of the time

🏖️ Benefits

• Equal opportunity employment • Ergonomically configured equipment • Team, department, and company meetings • Mentor lessons • At-will employment