Group Accounts Representative (Administrative)
TITLE: Group Accounts Representative
JOB CODE: N01605
GRADE LEVEL: 23
FLSA JOB STATUS: Non-Exempt
DEPARTMENT: Group Accounts
REPORTS TO: Receivables & Eligibility Supervisor
DATE WRITTEN: March 2023
General Description
Establish and maintain accurate and timely group set up and eligibility to ensure correct billing and claims processing for group clients and Individual and Family plans, as assigned. Bill, reconcile and secure payments to ensure outstanding receivables remain within department guidelines. Perform follow up on delinquent receivables according to departmental guidelines, up to and including suspension and/or termination, engaging group client benefit leaders and sales/marketing representatives, as appropriate. Provide group clients with Web access. Promptly troubleshoot and respond to access issues reported by group clients. Complete system testing and projects as assigned.
Responsibilities
• Load and maintain accurate eligibility into administration system. Work with the IT department and the EDI Operations team or to help troubleshoot problems with the electronic eligibility files. Work error reports timely and contact clients for missing information to complete enrollment processes.
• Supply groups with timely and accurate ID cards, in compliance with the corporate guarantees, and benefit information.
• Set up new groups and load the premium rates in the system. Notify the EDI Operations team to load initial eligibility and validate for the ID card process.
• Ensure the accuracy for rate set-up and invoicing as errors could result in significant financial impact to the company and jeopardize client relationships. Validate premium billing invoices.
• Determine and update the appropriate required system changes to the existing set-up, eligibility and rates based on the revised abstract. Coordinate with the IT department and the EDI Operations team to script for new policies impacting eligibility and billing. Validate the success of the scripting in back-up and production environments. Provide testing sign-off to IT for system implementation.
• Set-up COB, dual Delta and member merge eligibility for appropriate claim payment.
• Validate self-billed client payments are within exception threshold, then process adjustments to true-up billing account.
• Terminate eligibility and billing processes and complete the reconciliation for the final billing and collection of canceled groups. Process premium refunds, as appropriate.
• Monitor receivable balances to ensure timely payments and research disputed and/or unreconciled account balances. Responsible for detailed account reconciliation for all assigned groups as needed. Address account balance issues with the client to pursue resolution. Draft delinquency letters and monitor collection proceedings on delinquent balances. Suspend accounts in non-payment status to pend claim payments. Request non-payment cancellation following department guidelines.
• Promptly report payment discrepancies to Finance department for correction to ensure outstanding AR balance is accurate.
• Respond to inquiries and requests for group client matters. Meet with client personnel and Delta's account manager on an as needed basis to resolve any outstanding issues.
• Validate, assign and manage client user Web access for processing eligibility, billing and retrieving premium billing invoices. Serves as the first point of contact to facilitate client issue resolution with the Web team. Responsible for relating resolution to the client.
• Meet with project leads and Business Analysts to determine system enhancements and requirements. Perform testing functionality for system enhancements, new products and procedures within Enterprise system and the Website. Document and report issues and appropriate corrective resolution. Provide implementation sign off.
• Identify production issues and create work orders for eligibility and billing issues in Enterprise system and the website.
Other Responsibilities:
• Verify and post all manual debit/credit billing adjustments and sales into accounts receivable system within the Finance deadline. Validate posted amounts.
• Validate the premium billing invoice addresses, balance forward amounts, and invoiced amounts for the premium billing extract to the Delta premium billing system. Perform the invoice upload to the website. Validate the upload completed. Confirm the client e-mail notification process completed.
• Validate premium billing totals to the imported/posted totals for claims, premium/admin fees, MI HICA Tax and Individual and Family products. Submit work orders for discrepancies and confirm resolution outcomes.
• Request Delta initiated ACH payments within the Finance timeframe.
• Validate ID card totals to enrollments counts for new groups, open enrollment, and benefit changes. Facilitate creation or changes to logos and Alt IDs with vendor.
• Correct premium billing rate errors within the monthly invoice run.
• Review incoming mail for possible reprocessing. Obtain any missing information by phone or written correspondence.
• Perform Disaster recovery testing.
• Perform similar job-related duties as assigned.
Education, Skills, Personal Attributes, and Experience Required
• High school diploma required.
• One to three years of experience in receivables/bookkeeping and reconciliation processes.
• Proficiency in the following applications: Microsoft Word, Microsoft Excel and Microsoft Outlook.
• Candidate must have strong analytical skills with the ability to make timely and sound decisions.
• Be able to work effectively with customers, co-workers and management.
• Must be able to handle multiple projects in a timely manner.
• Ability to work effectively across the organization.
• Should possess strong verbal and written communications as well as effective listening skills.
• Proven subscription to the company's core values of integrity, trust and respect, innovation, stewardship, excellence and celebration.
Work Conditions
General office working conditions which may require sitting for extended periods of time
Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Specific vision abilities require the ability to focus distant and near objects clearly. While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands and arms to handle, feel and reach as well as operate a personal computer.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
