Job Summary

This role focuses on managing complex enrollment and billing activities within a commercial insurance environment using Facets membership capabilities ensuring accurate member data timely billing cycles and high operational reliability. The professional will work from office in a night shift model driving quality outcomes process improvements and consistent service for clients and members while collaborating closely with cross functional partners.

Responsibilities

Manage end to end enrollment and billing operations in a commercial insurance environment ensuring accurate member creation maintenance and termination activities aligned with client policies and regulatory standards.
Coordinate daily Facets membership processing tasks including new enrollments updates reinstatements and coverage changes to maintain reliable eligibility records and downstream billing accuracy.
Monitor billing cycles premium calculations and invoice generation activities to identify discrepancies early and drive timely resolution thereby supporting predictable revenue recognition for the organization.
Analyze complex enrollment and billing issues in Facets membership and commercial insurance enrollments diagnose root causes and recommend practical remediation steps that prevent recurrence and support operational stability.
Collaborate with operations finance and configuration teams to clarify benefit structures group setups and product rules so that enrollment data and billing outputs remain aligned with contractual commitments and client expectations.
Develop and update standard operating procedures for enrollment and billing processes ensuring documentation reflects current commercial insurance practices Facets membership configurations and control checkpoints.
Perform regular quality checks and reconciliation of member records billing files and payment postings to detect gaps between source data and system outputs driving corrective actions that protect data integrity and customer trust.
Provide detailed status reporting on nightly batch runs production issues and backlog items in enrollment and billing enabling stakeholders to make informed decisions about priorities and resource allocation.
Support incident and defect management by validating reported problems in Facets membership and enrollment workflows preparing clear analysis notes and partnering with technical teams for timely fixes.
Guide process optimization efforts that streamline enrollment intake mapping and validation steps reducing manual touch points and improving turnaround time for commercial groups and individual members.
Coordinate user acceptance validation for changes impacting enrollment and billing rules crafting realistic test scenarios based on commercial insurance use cases to confirm that system updates work as intended.
Engage with internal clients and business partners to understand upcoming plan changes group additions and billing requirements translating those needs into precise enrollment processing tasks and timelines.
Uphold compliance with relevant commercial insurance regulations and internal audit controls across all enrollment and billing operations ensuring documentation and system evidence are maintained for review.

Qualifications

Possess strong applied experience in Facets membership functions including configuration awareness enrollment transactions and eligibility data management in a commercial insurance setting.
Demonstrate deep practical knowledge of commercial insurance enrollment processes such as group and member setup coverage tier changes qualifying events and related billing dependencies.
Apply solid understanding of medical insurance billing concepts including premium calculation logic invoice cycles grace periods and reconciliation practices to support accurate financial outcomes.
Use analytical abilities and attention to detail to interpret enrollment source files identify data issues and design validation checks that improve overall data quality for downstream systems.
Bring experience working in structured operations environments with night shift schedules maintaining productivity adherence to timelines and consistent coordination with cross site partners.
Exhibit capability to document procedures create clear operational notes and communicate complexities in enrollment and billing processes to both technical and nontechnical stakeholders.

Certifications Required

Preferred certifications include health insurance specialist certification or professional training in Facets administration or payer operations.

TL-Enrollment & Billing