COBRA Specialist I

Eligibility & Enrollment Irvine, California


Description

You spend more than half of your waking hours working. Make these precious, fleeting moments matter by working for an organization and a cause you can believe in. 

Western Growers exists for one reason only: to ensure the future viability of its members – the hard-working, salt of the earth farmers who grow the fruits, vegetables and tree nuts that feed our nation and nourish our bodies. But their way of life, their ability to pass their multi-generational farms and family legacies on to their children and grandchildren, is being jeopardized by a host of threats, many of them beyond their control. They face a growing litany of laws and regulations that make it increasingly difficult and expensive to do business. 

Our members depend on us to help them remain competitive and profitable in spite of these trying circumstances, which we do by fighting – heart, and soul – for them every single day. We passionately advocate for them in the halls of Congress and on the steps of the state capitol. We actively facilitate the advancement of technology designed to help them become more efficient and less dependent on diminishing resources. We diligently provide health insurance to their farmworkers, as well as other insurance solutions tailored to the unique business. We do all of this, and more, from a position of leadership in the agriculture industry, which requires a team of intelligent, inquisitive and innovative individuals sold out for our common purpose.

To learn more watch our Company Video!

Job Description Summary

Performs Notification, Enrollment and Billing tasks for Consolidated Omnibus Budget Reconciliation Act COBRA/Retiree Administration for Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management (PCMI) clients who have contracted for this service.  Monitors researches and analyzes federal and state COBRA.

Qualifications

  • Four years of direct experience working with full Consolidated Omnibus Budget Reconciliation Act COBRA and Cal-COBRA Administration preferred. Two years’ experience combined with two or more years of business-related on the job training in the healthcare field accepted.  
  • Knowledge of generally accepted Health Care Eligibility and Billing procedures as well as Health Insurance Portability and Accountability Act HIPAA and Employee Retirement Income Security Act ERISA legislation.
  • Advanced computer skills in Microsoft Office Suite and the ability to develop a strong proficiency working with a proprietary Health Care system.
  • Experience providing Customer Service to a variety of client and subscriber contacts via email and telephone.
  • Ability to research and resolve technical issues and client/subscriber problems as they arise with minimal direction.
  • Excellent verbal and written communication skills which includes modern business communications, formatting of professional letters, reports and phone etiquette.
  • Proven project management abilities –including time and task management, establish priorities and working collaboratively to meet deadlines General knowledge of health insurance operations and industry.
  • Spanish verbal/written abilities preferred.

Duties and Responsibilities   

COBRA Process Management & Maintenance

  • Perform Notification, Enrollment and Individual Billing (Coupon, Invoice or Automated Clearing House (ACH) functions for all WGAT and PCMI COBRA accounts in accordance with Federal Laws and State laws - in addition to the Participation Agreements, Employer Policy Statement, Eligibility Guidelines and/or Summary Plan Descriptions.
  • Develop and maintain daily status and production reports for COBRA Administration for company and client reporting.
  • Provide education and assistance to WGAT and PCMI internal employees, clients and COBRA Participants relative to Federal and State COBRA laws/regulations, funding and payments.
  • Research and correct cash application issues in Healthcare Common Procedure Coding System Determine out of balance ledger items on accounts.  Contact subscribers to explain and to resolve billing/payment discrepancies. Verify refunds for terminations and/or overpayments.
  • Maintain a HIPAA compliant workstation and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client and enrollee data.
  • Consistently meet processing cycle time standards and production due dates as set forth by management.

Customer Service

  • Provide timely and effective Customer Service to clients and subscribers for requests, inquiries or issues concerning enrollment and/or billing items on their account.
  • Interface effectively with internal departments and external vendors, brokers or other business contacts to coordinate interrelated activities and to resolve eligibility and/or billing issues as they arise.
  • Serve as a representative of WGAT and PCMI displaying professionalism, knowledge, customer service, and discretion in all interactions with other members of the WGAT and PCMI community and their customers.

Other

  • Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. This job exists to serve directly (or indirectly) to someone in the fresh produce industry. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
  • All other duties as assigned.