Job Summary
This hybrid night shift role for TL Enrollment and Billing focuses on managing complex healthcare product enrollment and billing processes within commercial insurance. The candidate will drive accuracy in member enrollment data premium calculations and billing reconciliation to support compliance and client satisfaction. With eight to ten years of experience the role ensures operational excellence while collaborating across teams using strong English communication skills to improve service o
Responsibilities
- Lead end to end enrollment processing for commercial insurance members in healthcare products ensuring accurate capture of demographic and coverage details to support timely and error free policy activation.
- Oversee billing setup and premium calculation for new and existing commercial insurance accounts ensuring that rating rules product configurations and policy terms are applied correctly for financial integrity.
- Coordinate with operations and configuration teams in a hybrid work model to resolve enrollment and billing discrepancies ensuring that each case is analyzed root causes are documented and resolutions prevent recurrence.
- Manage night shift workflow for enrollment and billing queues by tracking daily volumes allocating work items and monitoring service levels so that turnaround time and quality targets are consistently met.
- Review complex enrollment change events such as adds terms and reinstatements for commercial insurance groups to ensure that coverage changes align with client contracts regulatory norms and member expectations.
- Validate billing files invoices and payment application reports from healthcare product systems ensuring that all charges adjustments and credits reconcile with enrollment data and agreed billing schedules.
- Collaborate with client facing teams to interpret and implement commercial insurance benefit designs contribution structures and eligibility rules so that enrollment and billing configuration in systems reflects contractual commitments.
- Provide detailed data analysis on enrollment and billing trends including error patterns revenue impact and operational bottlenecks to support process improvements and informed business decisions.
- Monitor compliance with internal controls and regulatory guidelines related to healthcare products and commercial insurance enrollment ensuring that documentation audit trails and approvals are complete and accessible.
- Guide team members in handling complex enrollment and billing scenarios by sharing domain knowledge reviewing work output and reinforcing standard operating procedures to uplift overall team performance.
- Drive continuous improvement initiatives across enrollment and billing processes by identifying automation opportunities optimizing workflows and proposing system enhancements that increase efficiency and accuracy.
- Coordinate production support for healthcare product enrollment and billing issues during night shifts by logging incidents prioritizing resolution and validating fixes to protect service continuity.
- Contribute to organizational goals by ensuring that accurate enrollment and billing support timely access to coverage minimize financial leakage and strengthen trust among employers members and partners. Qualifications
- Possess eight to ten years of hands on experience in healthcare product operations focusing on enrollment and billing for commercial insurance accounts with a proven record of meeting quality and service standards.
- Demonstrate deep domain expertise in commercial insurance enrollment processes including group setup member eligibility verification dependent coverage and life event handling for varied client segments.
- Apply strong working knowledge of healthcare product platforms and billing modules to configure plans manage rate tables and troubleshoot data issues affecting invoices and premium statements.
- Utilize advanced analytical and problem solving skills to interpret enrollment and billing data identify root causes of discrepancies and propose pragmatic solutions aligned with business priorities.
- Exhibit excellent English communication skills in reading writing and speaking to document complex cases collaborate with cross functional stakeholders and explain technical findings in clear terms.
- Maintain high attention to detail and process discipline in a hybrid work environment managing night shift responsibilities while adhering to security compliance and governance requirements.
- Show capability to mentor and support peers in enrollment and billing practices by sharing knowledge participating in calibration sessions and promoting consistent adherence to operational standards.
Certifications Required
Preferred certifications include health insurance or healthcare administration certification and any recognized healthcare product or medical billing certification.
Über Cognizant
Cognizant (NASDAQ: CTSH) i ist ein Technologiedienstleister und Entwickler von KI-Lösungen. Wir schlagen die Brücke zwischen KI-Investitionen und echtem unternehmerischem Mehrwert, indem wir ganzheitliche Full-Stack-KI-Lösungen für unsere Kunden entwickeln. Mit unserer fundierten Branchen-, Prozess- und Engineering-Expertise integrieren wir die spezifischen Anforderungen von Unternehmen passgenau in Technologiesysteme. So entfalten wir das menschliche Potenzial, erzielen greifbare Ergebnisse und sichern globalen Unternehmen in einer sich rasant wandelnden Welt den entscheidenden Vorsprung. Erfahren Sie mehr unter cognizant.ai oder @cognizant.
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