Job Abstract

Workplace

Remote

Employment Type

Full Time

ID

2024-3000

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The Electronic Enrollment Specialist acts as an advisor, consultant, liaison, and problem-solver for on-line and electronic file customers and other areas of the Plan. The Electronic Enrollment Specialist must use knowledge of existing business practices, systems, procedures, policies, and their inter-relationships to ensure innovative and cost effective solutions to business and technical issues. The Electronic Enrollment Specialist is responsible for providing support to group customers and Plan personnel prior to, during and after implementation of the on-line electronic group enrollment & maintenance system at Capital Blue Cross customer locations. This includes responsibility for managing the design, documentation, and implementation of customers' requests. The Electronic Enrollment Specialist is also responsible for providing ongoing technical/business support to customers.

Duties and Responsibilities:

• Functions as project manager for implementation of the various electronic enrollment options. Consults with a customer during the development process to determine any special processing and system requirements to implement an automated enrollment process. Conducts meetings/conference calls as needed with the customer and CBC personnel during the testing of on-line and electronic file implementations. Prepares the electronic enrollment presentation materials, Service Agreement, confirmation document, implementation schedules, and documentation necessary for implementing a new electronic enrollment customer. Plans, organizes, and conducts formal technical training sessions on-site for electronic enrollment components and supports Marketing Representative interface with customers for all administrative functions. Reviews all changes to manual and automated processes to determine if revisions to existing procedures or new procedures are required. Makes necessary revisions to existing customer and procedures or develops new procedures as required. Notifies affected customers or areas when procedures are finalized. Works with IT to establish security access and User ID and communication links for electronic enrollment customers to be able to view and/or update enrollment information.
• Acts as the primary advisor/consultant for electronic enrollment. Responds to questions and determines the urgency and importance of system change requests/problems and their effects on the accounts. Makes recommendations on the feasibility of procedure and systems changes. Performs cost benefit analyses to support recommendations.
• Analyzes impact of new benefits/products and other business needs on existing manual and automated processes and proposes alternatives. Develops and designs solutions to customer business problems and requirements. Quantifies the cost and business benefits of the alternative solutions and makes recommendations. Develops user requirements to propose the most feasible, cost-effective solution to address the request.
• Recommends procedure and system changes to provide a more effective and efficient electronic enrollment process.
• Develops complete and accurate project documentation and implements training programs to assist customers and CBC personnel in adapting to system modifications.
• Guides and assists in the training of new specialists to develop a thorough knowledge tasks and requirements.
• Approves systems and procedure changes to increase automation or improve processing accuracy or timeliness. Approves the cost and business benefits of the alternative solutions and makes recommendations, as well as, approves recommendations for the most feasible, cost-effective solutions.
• Approves system specifications/proposals for accuracy, feasibility, cost-effectiveness, and compliance with business procedures/requirements and system flow/file interaction.
• Maintains a professional level of competence through continued education and exposure to methodologies and technologies.

Experience:

• High School diploma or GED.
• Prefer a bachelor’s degree in one of the following; business administration, health planning and administration, information systems, computer science.
• 3 years’ related experience experience.
• Knowledge of the health care industry. Prefer an understanding of Capital’s corporate structure. Includes knowledge of standards and policies and familiarity with business practices and procedures for multiple departments/systems, especially those related to claims administration, account administration, customer service, marketing, and corporate performance. Also includes an understanding of systems and the corresponding business practices and inter-relationships with other Plans.
• Knowledge of data processing terminology and concepts. Includes a technical understanding of technologies such as Facets, MMS, Secure Mail, SAF and ERT. Also includes knowledge of batch and real-time processing environments, familiarity with sequential vs. random processing concepts, and an understanding of remote teleprocessing concepts and microcomputer capabilities.
• Knowledge or experience in ACCESS, EXCEL, and PowerPoint. Also includes knowledge of Internet products and Microsoft Office Suite.
• Knowledge and/or direct interaction with the current Electronic File options/process, as well as, the ANSI 834 standards as they relate to enrollment processing and HIPAA Legislation.
• Ability to analyze problems and issues, determine impact, and develop business solutions for system changes involving multiple automated systems. Ability to act as a liaison and recommend solutions to a variety of departments, as well as, other Plans.
• Ability to plan, organize, lead, and control projects. Includes the ability to communicate in writing and verbally with technical and non-technical audiences. Also includes persuasion and negotiation skills to resolve differences with skill and understanding.
• Ability to perform duties with minimal supervision. Includes ability to act both independently and as part of a project team, as well as, the ability to adapt to changing priorities.
• Familiar with cost/benefit analysis techniques.
• Must possess a valid Pennsylvania driver's license.
• Ability to lead meetings and give presentations to both management and staff. Includes the ability to develop teamwork among diverse groups.
• Proficient in the operation of VDT, PCs and laptop computers. Familiarity with Ultra Edit is helpful.

Physical Demands:

Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions.