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Government Plans Senior Business Specialist I

at HMSA

Posted: 10/2/2019
Job Reference #: 5000508677006

Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Non-exempt

Job Summary

Coordinate and conduct auditing of enrollment records received manually and/or through automation for government lines of business to ensure data integrity and compliance with applicable laws, regulations, contractual performance standards as well as functional policies and procedures. Assist in tracking, researching all systems utilized, and reconciling monthly reports on enrollment and disenrollment related activities.

Minimum Qualifications

  1. Bachelor's degree or an equivalent combination of education and related work experience.
  2. Strong verbal and written communication skills.
  3. Good time and priority management skills.
  4. Good problem-solving skills.
  5. Basic knowledge of Microsoft Office.

Duties and Responsibilities

  1. Audit/validate enrollment records and related activities to ensure accuracy, completeness and timeliness.
  2. Evaluate and audit work to ensure correct knowledge/understanding of policies, process and/or procedures. Prior to submission of request to CMS must ensure that enrollment processing. activities are in compliance with applicable laws, regulations, contractual performance standards, and functional policies and procedures.
  3. Analyze results and recommend controls and/or procedure changes to ensure quality and performance standards are met.
  4. Support development of new or revise existing documentation. Assist with training internal staff on new or revised procedures and workflows.
  5. Assist with the analysis and reconciliation of internal and external enrollment reports across the various systems/applications utilized as well as in the timely and accurate completion of reports required by CMS, executives and other management staff.
  6. Meet department standards by passing department/unit training test and quizzes with an average score of at least 90%.
  7. Perform other duties as assigned.