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.

• Coordinate and confirm variations in custom benefits and eligibility.

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

• Participate in implementation meetings for new and renewing large groups, identifying customization needs, testing requirements, and deliverable timelines.

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

• Analyze group structure, billing, and reporting needs.

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

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

• Work with the Facets Business Support team on new product implementations.

• Create and distribute plan materials.

• Process changes in group demographics.

• Generate censuses and cross-check member information.

• Finalize premium rates for new enrollments and renewals.

• Collaborate with Actuarial and Underwriting teams.

• Monitor processing status and keep group notes updated.

• Verify appointed producers and enter relevant data into the appropriate systems.

• Conduct QA testing for new processes or Facets updates.

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

• Update and manage the team escalation board.

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

• Ensure adherence to accuracy standards for the department, CMS, and PacificSource PRISM metrics.

• Attend scheduled meetings and mentor sessions.

• Complete other assigned tasks.

⛳️ Requirements

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

• A high school diploma or equivalent is mandatory.

• Exceptional verbal and written communication skills.

• Basic proficiency in Excel.

• Strong typing abilities.

• Effective problem-solving capabilities.

• Ability to accurately interpret state and federal insurance regulations.

• Maintain familiarity with PacificSource procedures, policies, products, and contracts.

• Meet the performance and attendance expectations set by the department and company.

• Comply with PacificSource's privacy policy and HIPAA regulations regarding the confidentiality and security of protected health information.

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

• Communicate clearly and effectively.

• Capable of stooping, bending, sitting, and/or standing for extended periods, performing repetitive typing/sorting/filing tasks, and lifting and carrying files and business materials.

🏝️ Benefits

• Full-time employment.

• Work from home option available in Florida.

• Commitment to equal opportunity employment.

• Ergonomically designed work equipment.

• Participation in team, department, and company meetings, along with mentor sessions.

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