Develop and maintain a relationship with enrolled groups and brokers that lead to a successful renewal of the account, allow for the sale of new products, and provide a consistent base of support in the market. Implement corporate marketing strategies regarding pricing, products, and service. Provide effective problem solving for accounts through proactive communications, analysis, and consultative sales activities. Identify opportunities to exceed account expectations.

Conducts enrolled group annual renewals and completes all required paperwork following renewalProposes and sells managed care products to enrolled groups and/or their broker/agentProvides a primary resource cotnact and liasion for enrolled groups and/or their broker/agentEstablishes and maintains rapport with enrolled group decision makers and their broker/agentProvides ongoing education to enrolled group adminstrators and/or their broker/agent; distributes materials to group administratorsProposes and sells all anceilary products to enrolled group and/or theri broker/agent; completes all neccessary paperwork following sale.Follows up on proposoals outstandingMaintains a working knowledge of small group reform, IPA's, COBRA, HIPPA, etc. and other issues affecting enrolled groupsMaintains a working knowledge of the rating processEnsures an effective/smooth transition from new group sales to account management

Direct support of Account Executives;Answer phones, process mail & faxes, and respond to email and voice mail;Assist Brokers and Group Administrators with membership issues including, enrollment applications, changes to existing member's policies, termination guidelines, verify payment status, billing applications, knowledge of group billing, delinquency, and reinstatement guidelinesTroubleshoot with Brokers and Group Administrators with online systems including eBilling, eNroll, and eHealth services.Liaison with internal departments to address claim, membership, billing, and other service issues; Preparation of renewal and sales materials;Run quote options using Sales Logix including data entry of census, risk information, and benefit information; Print/Copy enrollment material and prepare packets;Communicate benefit information and verify claim information to group administrators, brokers, account executives and occasionally members.;Interact with other internal department to address group issues and /or request; Assist in preparation of group proposals;Follow-up to ensure completion and filing of correspondence, renewal paperwork, etc.;Assist Account Executive with renewal processes, assembling renewal packets, reports, etc.;Responsible for coding new applications and scanning for accuracy when there are product changes prior to sending to enrollment specialist.

Seven years claims experience which includes researching and identifying possible processing errors as well as comparing the group's Evidence of Coverage to how the benefits were loaded into the processing system.Resolve issues using a root cause format which identifies what caused the issue, what actions were needed to correct the issue, what proof the customer would receive ensuring that the concern had been resolved and finally follow-up if required. Create accurate inquiries regarding concerns using Facets, IPD Solutions Suite, and Mainframe (Reflections) according to company standards.Adhere to all HIPAA policies and procedures in order to protect the customers Protected Health Information.Assist Brokers and Group Administrators with membership issues including, enrollment applications, changes to existing member's policies, termination guidelines, verify payment status, billing applications, knowledge of group billing, delinquency, and reinstatement guidelines.Troubleshoot with Brokers and Group Administrators with online systems including eBilling, eNroll, and eHealth services.Maintain and or exceed department quality goals which are between 96.6% & 100% accuracy.Maintain or exceed department goals for phone accessibility which are between 6:45 and 7:15 hours per day.Communicate benefit information and verify claim information to group administrators, brokers, account executives and occasionally members.

One year in this position in order to explore other areas of the company.Assisted the provider community in obtaining prior authorizations for members being admitted to their facility.Loaded authorizations and notifications for approved and denied authorizations into the processing system.Interacted with the provider community advising them of Utilization Management decisions, status and giving direction as necessary. Keep current with terminology used in the medical field when answering/asking questions.Identifying and referring cases appropriately to Care Management and/or Transition of Care.Search for and key appropriate diagnosis and/or procedure code as part of the notification/prior authorization process.

Resolve customer concerns through telephone inquiries.Proven ability to problem solve and make decisions effectively.Document all calls and concerns through the FACETS inquiry systemReceived positive comments from employee reviews, as well as exceptional feedback from members.Experience with both provider and member callsResearch claims for possible adjustments, make calls to other entities on behalf of members to resolve issuesExcellent attendance record, dependable and cooperativeCompleted Claims processing training.