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Membership Representative I-III: Denver, CO (PS13061) in Denver, CO at Anthem, Inc.

Date Posted: 10/12/2018

Job Snapshot

  • Employee Type:
  • Location:
    Denver, CO
  • Job Type:
  • Experience:
    3 to 5 years
  • Date Posted:

Job Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

A Membership Representative I-III is responsible for enrollment, billing activities and/or maintaining assigned accounts

Please note: Manager will determine level based upon the selected applicant’s skill-set relative to the qualifications listed for this position.

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 Under-writing 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.  

Level I:
  • Must pass the appropriate pre-employment assessment.  
  • HS diploma or GED.
  • Up to 1 year of related experience; Or any combination of education and experience, which would provide an equivalent background.
  • Working knowledge of Medicare is required.
  • Facets experience is preferred.
  • WGS and/or MEDISYS experience preferred.
  • Prior experience in the healthcare industry knowledge preferred.
  • Proficient with MS Office (Word and Excel) preferred.

Level II:
  • 1-3 years relevant healthcare customer servicing experience which includes at least 1 year company membership experience; Or any combination of education and experience, which would provide an equivalent background.

Level III:
  • 3-5 years relevant membership experience which includes at least 2 years of company membership experience;  Or any combination of education and experience, which would provide an equivalent background.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.


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