Roles and Responsibilities
- Review kickouts/errors enrollment files where information is incomplete, missing or incorrect to be updated in client application.
- Manage task assignments through client software in the form of kickouts-system generate errors arising from incorrect processing, incomplete data submission or incorrect data conversion by the group software.
- Compile and analyze a comprehensive summary of errors for each group referred to as Group File Summary (GFS), to gain clarity on the nature and extent of processing discrepancy.
- Retrieve real-time data submitted by Groups, Brokers, or Aggregators from derived source and methodically reconcile it with the information captured.
- Evaluate discrepancies between submitted data and internal records. Perform validation, correction, and system updates to ensure data accuracy and consistency across platforms.
- Based on the verified data, corrective action taken, submit final decision/s through client software, maintaining a high standard of precision and error free reporting.
- Identify and escalate major discrepancies-those exceeding pre-defined thresholds or requiring additional review by preparing clear and concise communication and addressing them through structured email exchange with the client.
- Provides customer service to internal/external stakeholders, demonstrates flexibility and responsiveness to
meet customer needs on routine work independently
- Reviews and provides specific information to questions/concerns from internal/external stakeholders by applying core knowledge obtained for the role
- Reviews and enters all member level eligibility information into the appropriate system(s) including changes, additions and deletions
- Processes all member changes affecting billing including age change reductions, COBRA administration and terminations
- Maintains accurate member records by verifying dates, names, salary figures and other information provided
by groups
