Additionalinformation

Additional Information

Job Responsibilities

a. Review and ensure accuracy of billings for claims and administrative fees for self-funded, minimum premium and maximum liability groups using a high level of understanding and knowledge of funding arrangements and mathematical skills. Includes tracking and interpreting all new and renewal group paperwork to ensure accuracy and completeness.

b. Accountable for the review of weekly and monthly invoice reporting packages with a demonstrated ability to ensure accuracy and timeliness of customer bills. Includes completion of manual custom special reporting and reconciliations as needed for high profile groups which involves a thorough understanding of available billing reports and report assignments.

c. Responsible for bill generation and the utilization of multiple systems within necessary timeframes to ensure proper completion and sufficient time for quality assurance reviews. Timeframes are dependent based on market segment and system used which require comprehensive knowledge of timeframes specific to each system.

d. Accountable for reconciliation of complex premium payments to billings for fully insured individuals and groups to ensure accurate billings, balances and payments applied correctly. Billing knowledge is critical as each reconciliation is different based on what the group paid vs. the billed amount. Provide outreach to customer as needed regarding questions on the reconciliations.

e. Ensure accurate and timely production of new and renewing groups’ rates, which includes rate entry and quality assurance prior to bill generation. Apply comprehensive knowledge of regulations of billing processing to ensure processes follow corporate policies, procedures, underwriting guidelines and legal requirements. Deadlines vary depending on billing system used. Provide frequent outreach to Sales as needed to obtain missing and/or incomplete paperwork.

f. Utilize proficient understanding of the Exchange (ACA) business and compliance related issues to administer policies in accordance with applicable rules and regulations.

g. Review and ensure accuracy of billing for claims and administrative fees for ancillary products (i.e. flexible benefits, Health & Care Management fees, 3rd Party EOB fees). Includes working directly with vendor personnel on file errors and exceptions.

h. Respond to complex group inquiries from Customer Service, Sales, Underwriting, Group Enrollment Team and Membership. Provide guidance and education as necessary.

i. Monitor reports and take the actions necessary to resolve issues. Resolution includes outreach to other team members and various departments. Necessary actions for resolution depend on the report issue which vary from report to report.

j. Document, follow and maintain auditable documentation of processes and procedures needed for compliance and training new staff. May engage in discussions with both internal and external auditors.

k. Responsible for set up and review of ancillary, fully insured, self-funded, minimum premium and maximum liability group billings and reports.

l. Serve as department subject matter expert in cross-functional projects and project test plan setup; participate in process improvement initiatives as necessary.

m. Analyze complex and highly customized benefit designs to determine appropriate rating configuration in various billing systems; provide support documentation and communication to support group billing setups.

n. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

Please inform us if you meet the definition of a "Covered DoD official".

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants

Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.

Companydescription

Company Description

Why Wellmark?

We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!

Learn more about our unique benefit offerings here.

Want to know more? You can learn about life at Wellmark here.

Jobdescription

Job Description

Responsible for managing processes within Billing Operations to deliver accurate and timely accounts receivable and billing services across multiple market segments, including high-profile groups. This role oversees rate setup and configuration in Wellmark’s billing systems, account and group setup, billing reconciliation, financial processing, and data maintenance across billing platforms. The position partners with internal business areas, members, and employer groups to resolve inquiries, clearly communicate billing processes, and provide a consistent service experience. Additional responsibilities include supporting audits and regulatory compliance, producing accurate reports, representing the department on rating configuration initiatives, and contributing to process improvements and business continuity efforts.

Qualifications

Required:

• Bachelor’s degree in accounting, finance, business or related field, or direct and equivalent work experience.
• 2+ years demonstrated experience in benefit processing, funding arrangements, enrollment, quality or billing operations, or in underwriting.
• High-level understanding and knowledge of accounting concepts, billing and payment policies and procedures, departmental HIPAA guidelines, data structure and systems.
• High-level understanding of different financial arrangements for fully insured, self-funded, controlled self-funded, minimum premium, and maximum liability groups. Full understanding of stop loss contract administration including outside stop loss arrangements.
• Solid experience in MS Office Suite, specifically Microsoft Excel experience (including formulas, pivot tables, etc.). Experience in pulling reports from Business Objects; developing queries in the system to extract data.
• Demonstrated ability to use critical thinking skills, manage multiple processes, work under pressure to meet timelines and accuracy guidelines or initiatives, and take ownership
• Demonstrated strong interpersonal skills with the ability to build relationships of collaboration and trust.
• Ability to work with and actively protect confidential information and data.
• Demonstrated ability to identify issues or inconsistencies and recommend alternative solutions.
• Ability to guide and train others on rating concepts and processes.

Preferred:

• Wellmark experience with working knowledge of Facets.
• Need to have a natural propensity for quality and research. Ability to educate and influence/be diplomatic.