The Enrollment and Billing Specialist III is responsible for the timely and accurate maintenance of Dean Health Plan (DHP), State Based Marketplace (SBM), Federally Facilitated Marketplace (FFM) enrollment of the Individual and Family Business Segment. Responsible for the accurate enrollment, continuation or extension of coverage, and billing process in accordance with contracts, member certificates, and regulatory entities. The Enrollment and Billing Specialist will maintain the integrity of data entered into HealthRules platform by interpreting Exchange based enrollment and maintenance files, appeals, and CMS Health Insurance Casework Systems (HICS) complaints within required regulatory timeframes.

Minimum Qualifications:

• Minimum requirement is HS diploma, or equivalent, plus 3 years of related work experience.
• Complete working knowledge and skill with ability to be fully proficient in administrative area.

Skills and Abilities

• Strong understanding of the Individual Market (Health Market Exchanges, enrollment, and Health Care Reform)
• Solid technical skills (Microsoft Excel, Word, Access, OBI)
• Strong written and verbal communication skills
• Strong drive for results and accountability
• Strong collaboration skills
• Exceptional judgement and decision making abilities
• Ability to work in a team environment and demonstrate strong attention to detail
• Demonstrate ability to perform highly advanced research; skills in problem identification and resolution

This position is a Hub role, which requires an employee to occasionally come onsite to the Madison office for applicable heads-up work once every other week. Frequency is determined by business need as decided by leadership.

This position is a Hub role, which requires an employee to occasionally come onsite to the designated office – Madison – for applicable heads-up work. Frequency is determined by business need as decided by leadership.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)