Job Summary
Serve as an experienced enrollment and billing team professional managing complex benefits open enrollment activities in a hybrid work model during night shifts. Coordinate payer and provider requirements safeguard HIPAA compliance and support accurate member data premium calculations and billing accuracy to improve client satisfaction and operational efficiency.
Responsibilities
- Manage end to end benefits open enrollment processing to ensure accurate capture of member elections and timely updates in enrollment systems for payer and provider stakeholders
- Coordinate enrollment data validation and reconciliation activities so that member coverage records premium calculations and group level details remain consistent across internal and external systems
- Monitor daily and nightly enrollment and billing transaction queues to identify exceptions investigate root causes and drive prompt resolution that protects member coverage continuity
- Document and maintain standard operating procedures for enrollment and billing workflows so that process consistency quality and audit readiness are continuously improved
- Collaborate with payer and provider operations teams to interpret benefit plan designs eligibility rules and product changes and translate them into precise enrollment and billing configurations
- Apply HIPAA regulations in daily work by safeguarding protected health information following secure handling procedures and escalating potential privacy incidents for review
- Analyze enrollment and billing metrics such as turnaround time accuracy and exception volume to identify improvement opportunities that enhance service quality and reduce rework
- Support configuration of enrollment rules billing cycles and rate structures in relevant tools to ensure that premium calculations and invoices align with payer and provider contracts
- Communicate clearly with internal stakeholders through concise written updates and structured night shift handoffs that maintain continuity across hybrid team members
- Respond to complex inquiries from client facing teams regarding member enrollment status coverage changes and billing discrepancies with clear explanations and corrective actions
- Contribute to testing activities for system enhancements regulatory changes or new benefit programs by validating enrollment and billing scenarios against expected outcomes
- Guide new team members on core enrollment and billing concepts HIPAA compliant practices and domain nuances for payer and provider operations without acting in a formal leadership capacity
- Align daily enrollment and billing decisions with company goals by reducing billing errors protecting member data privacy and supporting affordable and reliable access to care
Qualifications
- Possess four to five years of hands on experience in benefits open enrollment processing including eligibility updates event handling and member level changes in health insurance contexts
- Demonstrate deep practical knowledge of HIPAA privacy and security requirements as applied to enrollment billing and information exchange between payer and provider organizations
- Bring strong domain exposure to payer operations including benefit structures premium rating concepts claims impact from enrollment accuracy and group account relationships
- Show working experience with provider networks and rosters including how enrollment choices influence provider participation member assignment and billing flows
- Exhibit the ability to interpret plan documents benefit summaries and enrollment rules and convert them into accurate operational steps and system configurations
- Display advanced proficiency with spreadsheets and enrollment tools to analyze files perform reconciliations and track exceptions with strong attention to detail
- Demonstrate readiness to work in a hybrid environment on consistent night shifts while maintaining productivity quality and effective collaboration with distributed teams
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.
Aanvullende arbeidsinformatie
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