SME-Enrollment & Billing

Job Summary

Serve as a subject matter expert in enrollment and billing for a leading global payer organization applying strong MS Office proficiency and deep understanding of HIPAA to support accurate member data management timely premium processing and compliant reporting in a hybrid night shift role that ensures high quality service and operational excellence.

Responsibilities

• Manage end to end enrollment and billing activities for payer member accounts ensuring timely and accurate onboarding updates and terminations to support uninterrupted coverage and premium collection.
• Analyze enrollment and billing data using MS Office tools to identify discrepancies trends and root causes then document findings clearly to support corrective actions and process optimization.
• Validate member eligibility plan selections and premium calculations against payer business rules and regulatory requirements to maintain data integrity across core systems.
• Coordinate closely with operations configuration and finance teams to resolve enrollment and billing issues promptly minimizing revenue leakage and impact on member experience.
• Create and maintain detailed process documentation job aids and reference materials for enrollment and billing workflows that help standardize practices across hybrid team members.
• Prepare recurring and ad hoc reports in spreadsheets and presentations that summarize enrollment volumes billing status and aging items to inform management decisions.
• Apply HIPAA knowledge to safeguard protected health information in all enrollment and billing activities including secure handling of files emails and system access practices.
• Respond to complex internal inquiries related to member enrollment status premium payments and adjustments explaining resolution steps clearly and setting realistic expectations on timelines.
• Support quality assurance reviews by providing transaction level details clarifications and evidence and implement agreed remediation steps to improve accuracy and compliance.
• Contribute to continuous improvement initiatives by suggesting practical enhancements to templates macros and validation checks in office productivity tools that reduce manual effort and errors.
• Collaborate with training and operations stakeholders to onboard new team members in night shift sharing domain insights on payer specific enrollment and billing nuances through structured walkthroughs.
• Monitor daily work queues and service level commitments prioritizing high impact enrollment and billing tasks to ensure timely completion and positive impact on member satisfaction.
• Participate in periodic audits and internal reviews related to enrollment and billing processes providing transparent responses and supporting documentation that demonstrate strong control adherence.

Qualifications

• Possess three to four years of hands on experience in payer domain enrollment and billing operations including member data maintenance premium processing and adjustment handling.
• Demonstrate strong practical proficiency in office productivity software for data analysis reporting documentation and communication within a fast paced operations environment.
• Exhibit sound working knowledge of HIPAA regulations as they relate to enrollment and billing applying privacy and security principles consistently in daily work.
• Show proven ability to interpret payer plan rules benefit structures and billing modalities translating them into accurate system updates and calculations.
• Display effective written and verbal communication skills suitable for night shift collaboration with cross functional teams and stakeholders.
• Maintain high attention to detail numerical accuracy and problem solving aptitude when handling large volumes of enrollment and billing transactions.
• Adapt well to a hybrid work model using secure remote access and collaboration tools to maintain productivity compliance and service quality without travel requirements.

Over Cognizant  
Cognizant (NASDAQ: CTSH) is een bouwer van AI-oplossingen en een leverancier van technologiediensten. Wij slaan de brug tussen AI-investeringen en ondernemingswaarde door het bouwen van full-stack AI-oplossingen voor onze klanten. Onze diepgaande kennis van sectoren, processen en engineering stelt ons in staat om de unieke context van een organisatie te verankeren in technologische systemen. Deze systemen versterken het menselijk potentieel, realiseren tastbare resultaten en geven wereldwijde ondernemingen een voorsprong in een snel veranderende wereld. Ontdek hoe op cognizant.ai of @cognizant.

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