Membership Eligibility Processor
Work from home Within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated Membership Eligibility Processor, are living our mission to make health care easier and lives better. As a member of the Sales Support and Operations, our Membership Eligibility Processor establishes and maintains accurate subscriber and member level eligibility through processing of new applications, member additions and deletions, policy revisions, demographic changes, renewal changes and any other maintenance affecting eligibility, all-in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
* High school diploma or GED
* Minimum of 6 months of data entry experience
Skills and Attributes:
* 30 words per minute (wpm) keying speed; 10-key proficiency by touch (without looking at keypad); demonstrated ability to meet or exceed accuracy and production standards
* Detail-oriented and self-motivated with proven ability to maintain focus and accuracy while working independently; dependable with attendance at or above departmental standards
* Ability to exercise judgment, initiative, and discretion in confidential, mature, and sensitive manner when handling protected or sensitive information
* Strong interpersonal skills with ability to establish effective working relationships with staff and customers across various departments and levels
* Understanding of mathematical calculations and concepts; ability to organize and prioritize work effectively to meet production targets and deadlines
* PC experience required including proficiency with Word, Excel, Outlook, and similar software applications, comfortable with data entry software and systems
* Ability to communicate effectively in both written and verbal formats; medical terminology preferred for WSHIP health questionnaire processors; experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
* Process individual, small, large, trust, and specialized group enrollment applications; calculate appropriate waiting period credit, eligibility data, and effective dates; enter benefits, bank draft identification information, name, social security number, address, family members, and primary care physician information with network coding consistent with contract requirements
* Review, maintain, and enter changes on individual and/or group & trust accounts including change of effective date(s) for subscriber coverage or subscriber dependents, addition or deletion of insured or dependents from coverage; generate group or individual billings; order member cards; identify and prioritize work to meet deadlines including state requirements for timeliness
* Place calls to obtain information required to complete application processing such as calling an employer, member, or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan; provide customer service to internal customers and may place and track outgoing calls to external customers including groups, agents, and subscribers
* Perform all eligibility tasks accurately and timely to meet MTM requirements; incorporate and apply changes made to Membership Accounting, Underwriting, and State and Federal policies and procedures to ensure current requirements are met; comply with
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