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Account Specialist - Self-Funded at Independent Health Assoc., Inc. in Williamsville, New York

Posted in General Business 30+ days ago.

Type: Full-Time

Job Description:

... ... ... ... ... ...  Overview

The Account Specialist is responsible for relationship management functions with self-funded employer groups. The Account Specialist provides employer centric servicing and administration by collaboratively working with sales, system configuration, membership operations, claims, customer service and medical management resulting in employer satisfaction....  Working in collaboration with the Account Manager, and a variety of internal departments the Account Specialist supports implementation of new business as well as retention of...  an assigned book of business. The Account Specialist directly services employers and/or their 3rd parties through the administrative processes associated with account set up, renewal and managing membership data....  They verify and resolve eligibility, claims and data issues and process account and membership data....  The Account Specialist tracks and audits account set up and the production of membership materials....  They work directly with the Account Manager and/or Sales and employers to plan and administer open enrollment or other significant account activities....  The Account Specialist will facilitate the electronic enrollment implementations and on-going administration....  They will understand, interpret and communicate policy and procedures appropriately with internal and external contacts....  The Account Specialist recognizes and appropriately triages operational issues or opportunities and billing and receivable issues.

  • High School Diploma or GED required. Associate.........s degree preferred.

  • Three (3) years of experience in business to business sales support, customer support or account servicing required; self-funded health care experience preferred.

  • Demonstrated ability to make decisions consistently that effectively balances the administration of policy with rational, logical customer centric servicing.

  • Demonstrated ability to understand and articulate complex systems, process and/or concepts and influence outcomes through clear and effective communication and collaboration.

  • Excellent verbal, written and interpersonal communication skills required.

  • Proficient in desktop tools including Word, Excel and experience preferred.

  • Capacity to understand and manage regulatory requirements and professionally participate in external audits and client meetings.

  • Ability to work over time, flexible hours, weekends and holidays is required and a condition of employment.

  • Local travel required. Any IH employee who uses a motor vehicle in the course of their duties representing Nova must be compliant with New York State Motor Vehicle laws and must follow the Policy that pertains to Driver.........s License Requirements as a condition of employment.... ... ... ... ... ... ... ... 

  • Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Key Accountabilities

A. Account Service and Administration:

  • Appropriately respond to employer and member phone calls, e-mails, faxes and other inquiries about group account and membership operations policies and procedures.

  • Proactively discuss, plan and then internally administer open enrollment, new plan, new account or other significant activities with employer.

  • Administer or oversee electronic enrollment implementations and on-going administration of these processes.

  • Interact with 3rd party administrators in the management of membership data including on-line or e-mail acknowledgements.

  • Be accountable for and follow through to resolution any issue that cannot be immediately addressed.

  • Tailor servicing and administrative approach and involvement to each employer.........s requirements.

  • Initiate, monitor and verify membership materials production.

  • Understand, interpret and communicate policy and procedures in a helpful service oriented manner.

  • Provide educational assistance to employers where necessary to manage group account and membership operations within policies resulting in member centric outcomes.

  • Recognize and appropriately triage sales/product placement issues or opportunities and billing and receivable issues.

B. Production Processing:

  • Verify eligibility of new member enrollments and recognize and report potential instances of fraud or abuse.

  • Assist in systems testing and data verifications.

C. Systems Technology:

  • Maintain a level of technical, strategic, regulatory and operational expertise required to effectively manage and perform assigned duties.

*This position is an Independent Health position, but located at Nova.*

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant.........s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.