Group Processing Specialist II

Join PacificSource and help our members access quality, affordable care!

• →Process new group materials, change requests, member applications, and renewals for small and large fully insured groups, self-funded groups, and student health plans.
• →Coordinate and confirm custom benefits and eligibility variations as required.
• →Coordinate with teams to review and create new products or plan materials, as needed.
• →Attend new and renewing large group implementation meetings. Identify customization, testing needs, and timelines for deliverables.
• →Review group master applications, renewal confirmation forms, proposal requests, and various other forms or correspondence received. Follow up with internal teams for missing information.
• →Analyze new and renewing group structure, billing, and reporting requirements.
• →Enter group data into various applications including the Online Enrollment System and the Online Waiver System.
• →Validate product codes, financial codes, and other related codes for groups and subgroups.
• →Coordinate with Facets Business Support team for new product implementations as needed.
• →Create and distribute plan materials accurately and timely.
• →Process all group demographic changes.
• →Generate census and cross-reference member information on master application with final proposal census.
• →Process final premium rates for new group enrollments and group renewals.
• →Coordinate with Actuarial and Underwriting teams as needed.
• →Track group processing status and maintain group notes.
• →Verify appointed producer and enter data into the appropriate system.
• →Provide essential QA testing of new processes or updates in Facets and other systems as needed.
• →Assist with Commercial Individual and Government product line group configurations, as necessary.
• →Update and maintain the team escalation board.
• →Develop and update procedures, job aids, and lessons as needed.

• →Maintain accuracy standards as required to meet department, CMS and PacificSource PRISM measures.
• →Meet department and company performance and attendance expectations.
• →Attend team, department, company meetings, and mentor lessons as scheduled.
• →Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• →Perform other duties as assigned.

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.

• We are one team working toward a common goal.

• We are each responsible for customer service.

• We practice open communication at all levels of the company to foster individual, team and company growth.

• We actively participate in efforts to improve our many communities-internally and externally.

• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.