Group Accounts Representative

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-pa...