Group Processing Specialist II

This is a fully remote position, open to applicants in Florida.

📋 Description

• Manage the processing of new group materials, change requests, member applications, and renewals for both small and large fully insured groups, self-funded groups, and student health plans.

• Organize and verify custom benefits and eligibility variations.

• Collaborate with teams to review and develop new products or plan materials.

• Participate in implementation meetings for new and renewing large groups.

• Identify customization needs, testing requirements, and timelines for deliverables.

• Review group master applications, renewal confirmation forms, proposal requests, and associated correspondence.

• Follow up with internal teams to obtain missing information.

• Analyze group structures, billing, and reporting necessities.

• Input group data into the Online Enrollment System and Online Waiver System.

• Validate product, financial, and related codes for groups and subgroups.

• Coordinate with the Facets Business Support team for the implementation of new products.

• Create and distribute plan materials.

• Process demographic changes for groups.

• Generate census data and cross-reference member information.

• Process final premium rates for new enrollments and renewals.

• Collaborate with Actuarial and Underwriting teams.

• Monitor group processing status and keep detailed group notes.

• Verify appointed producers and enter the data into the relevant system.

• Conduct QA testing for new processes or updates in Facets and other systems.

• Assist in the configuration of group settings for Commercial Individual and Government product lines.

• Update and maintain the team escalation board.

• Develop and revise procedures, job aids, and training materials.

• Ensure compliance with accuracy standards set by the department, CMS, and PacificSource PRISM measures.

• Meet the performance and attendance expectations of the department and company.

• Attend scheduled meetings and conduct mentoring sessions.

• Adhere to PacificSource privacy policies and HIPAA laws and regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of 2 years of relevant experience in medical insurance or healthcare is required.

• A high school diploma or equivalent is required.

• Exceptional verbal and written communication skills.

• Basic proficiency in Excel.

• Strong typing abilities.

• Effective problem-solving capabilities.

• Capability to proficiently interpret state and federal insurance regulations.

• Ability to maintain an understanding of PacificSource procedures, policies, products, and contracts.

• Proficient in reading and comprehending both written and spoken English.

• Ability to communicate clearly and effectively.

• Capability to stoop and bend.

• Ability to sit and/or stand for prolonged periods.

• Ability to perform repetitive tasks such as typing, sorting, and filing.

• Ability to lift and carry files and business materials.

• Travel is required approximately less than 5% of the time.

🏝️ Benefits

• Equal opportunity employment.

• Ergonomically designed equipment.

• Participation in team, department, and company meetings and mentoring sessions.

• A values-driven, inclusive work environment.

• Flexible work-from-home arrangement.