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.

• Organize and confirm variations in custom benefits and eligibility.

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

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

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

• Analyze the structure of groups, along with billing and reporting needs.

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

• Validate product, financial, and related codes.

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

• Create and distribute plan materials.

• Process changes in group demographics.

• Generate census data and cross-reference member information with the final proposal census.

• Process final premium rates for new group enrollments and renewals.

• Coordinate with Actuarial and Underwriting teams.

• Monitor the status of group processing and maintain comprehensive group notes.

• Verify the appointed producer and enter relevant data into the appropriate system.

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

• 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 educational materials.

• Uphold accuracy standards for the department, CMS, and PacificSource PRISM measures.

• Attend scheduled team, department, and company meetings, along with mentoring sessions.

• Perform additional duties as assigned.

⛳️ Requirements

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

• A high school diploma or equivalent is mandatory.

• Excellent 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.

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

• Adhere to PacificSource privacy policy and HIPAA regulations related to the confidentiality and security of protected health information.

• Work in a general office environment equipped with ergonomically designed furniture.

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

• Communicate clearly and effectively.

• Ability to stoop, bend, sit, and/or stand for long periods, perform repetitive typing, sorting, and filing, as well as light lifting and carrying.

🏝️ Benefits

• Equal opportunity employment.

• Ergonomically configured equipment.

• Participation in team, department, and company meetings, along with mentorship lessons.

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