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Membership Representative I, II or III

Location: Denver, CO
JobFamily: Membership & Enrollment
Req #: PS72724
Date Posted: May 11, 2022

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? 

How you will make an impact:

The Membership Representative I is responsible for enrollment, billing activities and/or maintaining assigned accounts. Pre-employment test battery may be required.  Primary duties may include, but are not limited to:

  • 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.
  • Performs basic job functions with help from co-workers, specialists and managers on non-basic issues. 

The Membership Representative II is responsible for enrollment, billing activities and/or maintaining assigned accounts. Must be able to successfully perform all the duties of the Membership Rep I. Primary duties may include, but are not limited to:

  • 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 lists.
  •  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 for 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. 

The Membership Representative III is responsible for enrollment, billing activities and maintaining assigned accounts. Must be able to successfully perform all the duties of the Membership Rep II. Primary duties may include, but are not limited to:

  • 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 or concerns received by phone or mail.
  • Responsible for all 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.
  • Orders 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.
  • Fully proficient in all key areas; performs most complex work. 

Qualifications

Minimum Requirements for a Membership Representative I:

  • High school diploma or GED equivalent
  • Related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences for a Membership Representative I:

  • Computer proficiency and experience with multiple screens/systems preferred.

Minimum Requirements for a Membership Representative II:

  • High school diploma or GED equivalent
  • Minimum of 1 year relevant healthcare customer servicing experience which includes a minimum of 1 year membership experience with the company; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences for a Membership Representative II:

  • Computer proficiency and experience with multiple screens/systems preferred.

Minimum Requirements for a Membership Representative III:

  • Requires high school diploma or GED equivalent
  • Minimum of 3 years relevant membership experience which includes a minimum of 2 years of membership experience with the company; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences for a Membership Representative III:

  • Computer proficiency and experience with multiple screens/systems preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Applicable to Colorado Applicants Only
Hourly Pay Range* for Membership Representative I: $13.73/hr - $18.02/hr 

Hourly Pay Range* for Membership Representative II: $15.35/hr - $20.14/hr

Hourly Pay Range* for Membership Representative III: $18.19/hr - $23.88/hr 

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 
 
* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. 

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.