This position has the option to work hybrid or fully remote; Ohio residents preferred.Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.ResponsibilitiesMembership Services Specialist IProcesses routine and/or less complex enrollment and billing transactions for an assigned block of customers following underwriting guidelines. Maintains eligibility records on various claims processing systems. Controls billing and reconciliation processes on membership and accounts receivable systems. Responds to standard inquiries from customer group and broker representatives.· Processes routine and/or less complex membership enrollment transactions, such as additions, updates, contract changes, billing adjustments, cancellations, and invoice reconciliation.· Reconciles invoices and enrollment rosters, reviews, and balances figures in the Accounts Receivable (A/R) systems against customer records and processes A/R reports.· Responds to and research routine and/or less complex customer inquiries via email, phone, or written correspondence.· Performs other duties as assigned.Membership Services Specialist IIUnder general supervision, processes routine to moderately complex enrollment and billing transactions for an assigned block of customers following underwriting guidelines. Maintains eligibility records on various claims processing systems. Controls billing and reconciliation processes on membership and accounts receivable systems. Responds to routine to moderately complex inquiries from customer group and broker representatives.· Determines eligibility of applicants and processes routine to moderately complex enrollment transactions such as additions, updates, contract changes, billing adjustments, cancellations, and correspondence within stated timeframes.· May add and update group records and rate tables. Reviews and schedules auto-enrollment jobs received from email. Reviews outgoing reports, complex invoices, and letters prior to distribution to group officials.· Responds to and research routine to moderately complex customer inquiries via email, phone or written correspondence.· Reconciles invoices and enrollment rosters, reviews, and balances figures in the Accounts Receivable (A/R) systems against customer records and processes A/R reports.· May enter rate tables, explains invoice discrepancies to brokers and sales, processes billing transactions on two billing systems.· Participates in onsite and phone client implementations meetings to provide support to sales.· Performs other duties as assigned.Senior Membership Services SpecialistUnder moderate supervision, processes routine to varied and/or complex enrollment and billing transactions for fully insured premium for health and life products including any applicable fees. Responds to internal clients, groups, and brokers regarding routine to varied and/or complex eligibility and billing inquiries. Trains more junior level Specialists in routine processing and assists with special projects as needed.· Determines eligibility of applicants and processes routine to varied and/or complex member enrollment transactions such as group additions, terminations, renewals, etc. May add and update group records and rate tables. Researches and responds to routine to varied and/or more complex eligibility inquiries via fax, postal mail or e-mail regarding eligibility feeds and files, and eligibility issues on vendor websites (i.e, RX, vision).· Reconciles invoices and enrollment rosters, reviews, and balances figures in the Accounts Receivable (A/R) systems against customer records and processes A/R reports.· Reviews and schedules complex auto-enrollment jobs. Assists in testing changes to those jobs as well as processing test cases for upgrades to the billing and enrollment systems.· Orients, trains, and assists more junior level Specialists in routine processing, and collaborates with other departments on group set ups, providing assistance as needed.· Participates in onsite and phone client implementation meetings to provide sales support.· Analyzes deficiencies in processes/procedures and recommends improvements to the Lead Membership Enrollment Specialist.· Performs other duties as assigned.QualificationsMembership Services Specialist I· Associate’s Degree in Business Administration, Communications or related field, or equivalent combination of training and experience.· 1 year support experience in benefits administration, human resources, or the insurance industry, preferably in health insurance.· Basic knowledge of health insurance products.· Intermediate Microsoft Office skills.· Good keyboarding skills; minimum of 35 words per minute.· Basic math and accounting skills.· Ability to interpret regulation documents including following procedures written to comply with federal and state law.Membership Services Specialist II· Associate's Degree in Business Administration, Communications or related field, or equivalent combination of training and experience.· 1 year as a Membership Services Specialist or equivalent 2 years’ experience in benefits administration, human resources, or the insurance industry, preferably in health insurance.· Knowledge of health and life insurance products and billing and group membership practices and processes.· Intermediate Microsoft Office and database applications skills.· Good math and accounting skills.· Understanding of basic underwriting regulations for large and small groups.· Good keyboarding skills; minimum of 35 words per minute.· Ability to interpret regulation documents including following procedures written to comply with federal and state law.Senior Membership Services Specialist· Associate's Degree in Business Administration, Communications or related field, or equivalent combination of training and experience.· 3 years’ experience as a Membership Services Specialist or equivalent experience in health insurance membership and billing.· Strong knowledge of health and life insurance products and billing and group membership practices and processes.· Intermediate to advanced Microsoft Office, database applications and health insurance operations systems skills.· Good math and accounting skills.· Ability to interpret documents of varied complexity.· Understanding of basic underwriting regulations for large and small groups.Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:A Great Place to Work:
We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
Discounts at many places in and around town, just for being a Medical Mutual team member.
The opportunity to earn cash rewards for shopping with our customers.
Business casual attire, including jeans.
Excellent Benefits and Compensation:
Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
An Investment in You:
Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual:Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.Title: Membership Services SpecialistLocation: OhioRequisition ID: 2400195