Sr. Account Representative

UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The Senior Account Representative is responsible for processing complex enrollments and elections and applying monthly contributions from members/employers based on the Summary Plan Document (SPD) and Collective Bargaining Agreement. This is essential for providing participants with eligibility for health care coverage. This also includes reconciling monthly work reports and processing applications for Consolidated Omnibus Budget Reconciliation Act (COBRA) and processing and applying cash from members.  This position will process Qualified Medical Child Support Orders (QMCSO) by assessing the validity of the orders, responding to the agencies timely, adding dependents, and tracking eligibility.

This position is responsible for an account load with increasing complexity, which includes complex contribution plans, self-pay plans, and plans that include the processing of FMLA and vacation hours, complex hybrid plans, and complex retiree dental plans.  This position may also handle complex plans in 2 different regions.   This individual supports intermediate regression testing and runs intermediate queries/reports. This employee will support and train employers in ESS and handle the first phase of OLE/ HSP Plans.

In addition to the responsibilities listed above, this role will be responsible for providing support and training to new hires, and continuing education and training for their respective teams on new processes and procedures.  Auditing for coaching purposes will be provided to new hires and those individuals requiring additional support. This role will also respond to escalated inquiries in the absence of the supervisor.

ESSENTIAL DUTIES AND RESPONSIBILITIES 

• Determines if the member plan provides access to dependent coverage, and meets the requirements of the QMCSO 
• Ensures eligibility is updated timely to prevent problems with participants/dependents coverage seeking care
• Partners with vendors to update urgent eligibility requests 
• Escalates recurring issues that delay eligibility to management
• Applies credits and debits accurately in system
• Communication with both external and internal customers and providing excellent customer service
• Maintains all QMCSO and COBRA/HIPAA files, including enrollment and payment documents
• Maintains and monitors employee elections and related co-premiums
• Maintains, monitors and reviews proof documents for dependent coverage and related contribution
• Updates member file in the eligibility system with terminated employees and new hire information
• Verifies employer payments in US Bank to ensure all payments are processed
• Monitors employer reports and refers late employers to the Legal Department
• Monitors outstanding balances and notifies employers of monthly discrepancies through written correspondence.
• Notifies members of payment discrepancies and cancellations through written correspondence
• Reviews the weekly and monthly COBRA & Health Insurance Portability and Accountability Act (HIPAA) eligibility list for his or her accounts to ensure accuracy of qualifying events
• Updates appropriate systems to track compliance and ensures that coverage is provided in accordance with the terms of the QMCSO
• Trains new hires on new processes and procedures
• Documents training provided and provides feedback to the staff and the management team
• Audits accounts for purposes of coaching and development and provides feedback to the staff and management team

ESSENTIAL QUALIFICATIONS

• 3 ~ 5 years of related experience
• Working knowledge and experience in accounting, medical insurance, eligibility billing, delinquency procedures, reconciliation of payments, and collections
• Preferable experience in eligibility rules including COBRA and Health Insurance Portability and Accountability Act (HIPAA), Employee Retirement Income Security Act (ERISA), and an understanding of Collective Bargaining Agreements
• High school diploma or equivalent

Salary range for this position: Hourly $27.08 - $33.13. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a remote position.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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