Job Description
Position Summary:
The Group Implementation Specialist is responsible for reviewing documentation received from the Sales Representatives to identify how to input information into the claims and billing system to ensure proper processing. In addition, the Group Implementation Specialist prepares the legal group contracts and benefit plan booklets for both new and existing groups. The legal documents that the Group Implementation Specialist prepares are custom documents. In order to create these custom documents, the Group Implementation Specialist must possess extensive knowledge of Insurance Law and mastery skills of the suite of Microsoft Applications. The Group Implementation Specialist is required to work closely with Compliance for the filing of custom documentation for groups.
The Group Implementation Specialist is also responsible for inputting group benefits, eligibility information, rates, and broker information into the claims and billing system. In order to accurately input the group information, the Group Implementation Specialist must have an extensive knowledge of the following:
Product and plans information, Claims policies, procedures and Underwriting Guidelines, Billing and Eligibility procedures, policies, and applications, Commission Payment Process. In addition, the Group Implementation Specialist will be required to provide additional information for groups as requested. The Group Implementation Specialist also provides support to the Sales staff on a daily basis. The Group Implementation Specialist will also be asked to perform other duties or special projects on an as needed basis.
Essential Functions:
Work is performed in a team setting with multiple priorities and tasks, often working under time constraints.
Must possess mastery skills of the suite of Microsoft Applications.
Works closely with Sales Representative to ensure all documentation for new groups is received and information is validated to be correct before loading into claims and billing systems.
Identifies and inputs benefits and group structure that must be loaded into claim and billing system.
Frequent contact with group administrators, agents and consultants during new group implementation and renewals, requiring excellent customer service skills.
During group renewal process, the Group Implementation Specialist identifies any and all changes to group benefits or commission schedules and processes these changes to each account.
Creates the legal documents between clients, including the contract and booklets for both new groups and amended groups.
Creates customized contract documents and other customized documents as requested by internal and external customers.
Assists in maintaining master documents for all contracts.
Implements benefit amendments, rate amendments, eligibility transfers, and any other necessary changes into the claims and billing system.
Responsible for handling any communications materials (benefit summaries, contact updates for ASC updates, etc.) and updates any correspondences that are impacted by changes.
Responsible for updating information in the claims and billing system that determines both internal and external commission payments.
Completes Agent and Agency appointment with the BOI and modifies agent records when requested.
Works with outside printing companies to ensure that the printed materials meet contract quality and accuracy standards.
Creates 5500 Reports for external customers.
Prepares and issues Group reports (New Accounts, Renewals) and gathers information for Quarterly Board of Directors report.
Trains and assists team members as needed.
Qualifications/Education/Experience:
Education and experience equivalent to a two-year college degree. Four-year degree preferred.
Extensive knowledge of applications within Microsoft Suite.
Ability to collaborate with other internal teams, including but not limited to Sales/Account Management, Underwriting, Configuration, Provider Relations, and Back End Operations.
Must be comfortable working on multiple tasks and projects at once and be able to effectively prioritize workload.
Demonstrated success working in a fast-paced environment with tight deadlines and the ability to shift focus from one project to another quickly is critical.
Attention to detail is critical for success when reviewing group renewal information.
Prior customer service experience, including within a dental office, health care sales or service center. License to sell insurance preferred.
Must have excellent verbal and written communication skills with the ability to effectively communicate and interact with all levels of personnel and the general public.
Strong interpersonal and communication skills.
Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. Use of hands is required for such technological devices such as a computer, telephone and others. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. The employee will be required to travel (sometimes long distances) to attend required meetings.
Work environment: The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. The noise level in the work environment is usually minimal.