Long Term Care Operations Administration Specialist (Finance)

Job Description:

Summary:

The LTC Operations Administration Specialist performs timely and accurate data-entry, validation and transactional processing in the administration system in addition to providing service for customers and business partners. This role provides a high level of processes coverage, demographic, billing changes, processes billing and collections, commissions, enters, processes and adjudicates Long-Term Care claims, resolution of complex customer inquiries.

Essential Accountabilities:

• In accordance with established departmental procedures, corporate policies, member contracts and riders, will process, enter, modify insurance policies and information, payments, and request additional information needed, send correspondence when necessary and work closely with other required internal departments.
• Balances daily cash receipts, and/or research cash records according to transaction type. Initiates the necessary actions to balance daily cash records.
• Adjudicates, and/or researches claims according to policy specifications. Initiates the necessary corrective transactions to clear claims for payment or denial.
• Researches, interprets and responds to inquiries associated with simple claims transactions including those that do not require contract interpretation and/or lengthy historical audits. Performs claim calculation and adjudication; and daily check-run processing.
• Researches and interprets premium and non-premium cash records associated with Banking and Workday files.
• Performs accurate, timely data-entry and transactional processing of benefit changes, terminations, waiver of premium, demographic changes and responds to insureds with appropriate correspondence.
• Performs accurate, timely data-entry and transactional processing of nursing home, assisted living facility and home care claims.
• Reviews and verifies premium payments received electronically and physically, accepts, rejects, or processes insufficient funds, and prepares for deposit or processing according to administrative departmental procedure.
• Independent performs complex administrative system transactions, complex claims processing, claims history audits and policy interpretation.
• Provides service to customers, agents, and business partners while responding in a professional, efficient, and timely manner to enhance customer satisfaction. Must exercise discretion, patience, and professionalism always in responding to both internal and external customers.
• Documents, researches, interprets and responds to inquiries from internal and external customers, agents, and business partners concerning our products, services and policies in accordance with HIPAA and other legislative requirements.
• Resolves highly complex customer inquiries via telephone accurately & efficiently, resulting in acceptable quality, and performance.
• Participates in the training needed to learn regulations, systems, procedures, develop skills and initiate actions to accurately fulfill all requirements of the job.
• Ensures compliance to meet or exceed the Company production standards for time service, quality and customer satisfaction.
• Ownership and accountability for issue identification, remediation and resolution.
• Assess workloads in multiple departments and balance competing priorities to execute on internal and external expectations from customers and regulators.
• Initiates involvement for higher level responsibilities and proactively leads or assists in the resolution of escalated or systemic issues.
• Develops ideas and solutions to improve processes, procedures, and systems.
• Mentors and trains other staff members as needed.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• Five (5) years of experience in an advanced LTC Claims Admin Specialist, Policy Admin Specialist, or Customer Service position.
• Associate's degree in a related field. In lieu of a degree, three (3) years of data entry or customer service experience required.
• Advanced ability of multi-tasking to efficiently resolve a wide variety of complex administrative transactions and cash balancing reports.
• Intermediate computer processing proficiency.
• Intermediate analytical, reasoning and problem-solving skills.
• Ability to prioritize competing projects and priorities in different departments.
• Excellent communication skills and demonstrated abilities in dealing effectively with all levels of internal and external customers.
• Demonstrates ability to identify the root cause and trends of the systemic problem in order to recommend and then implement solutions.
• Ability to work independently, cross functionally with a high level of accuracy.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Ability to use a headset to listen to customer conversations required.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade N6: Minimum $21.83 - Maximum $34.9

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.