Group Processing Specialist II

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

📋 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.

• Facilitate and confirm 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 delivery timelines.

• Review applications, renewal documents, proposal requests, and correspondence; follow up on any missing information.

• Analyze group structure, billing, and reporting requirements.

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

• Verify product, financial, and related codes.

• Work with the Facets Business Support team to implement new products.

• Create and distribute plan materials.

• Process changes to group demographics.

• Generate census reports and cross-reference member details with the final proposal census.

• Calculate final premium rates for new enrollments and renewals.

• Coordinate with Actuarial and Underwriting teams.

• Monitor group processing status and maintain accurate group notes.

• Verify appointed producers and input data into the necessary system.

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

• Assist with configurations for Commercial Individual and Government product lines.

• Update and maintain the team escalation board.

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

• Attend scheduled meetings and mentor lessons.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of 2 years of experience in medical insurance or a healthcare-related field is required.

• High school diploma or equivalent is necessary.

• Exceptional verbal and written communication skills.

• Basic proficiency in Excel.

• Strong typing skills.

• Effective problem-solving abilities.

• Capacity to proficiently interpret state and federal insurance regulations.

• Ability to stay informed about PacificSource procedures, policies, products, and contracts.

• Maintain accuracy standards necessary to comply with department, CMS, and PacificSource PRISM measures.

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

• Adhere to PacificSource privacy policies and HIPAA laws regarding confidentiality and security of protected health information.

• Ability to read and understand both written and spoken English.

• Capability to communicate clearly and effectively.

• Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive tasks such as typing, sorting, and filing, and lift/carry files and business materials.

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

🏝️ Benefits

• Equal opportunity employment.

• Ergonomically designed equipment.

• Meetings for team, department, and company.

• Mentor lessons.

• At-will employment.