UNITE HERE HEALTH serves 200,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The Account Representative I is responsible for processing complex enrollments and elections for health insurance and applying monthly contributions from employees/employers based on the Summary Plan Document (SPD) and Collective Bargaining Agreement (CBA). They ensure compliance with these documents which are crucial for granting participants eligibility for health care coverage. This position also includes reconciling monthly work reports, processing and applying cash payments from employers and participants. They also process applications for Consolidated Omnibus Budget Reconciliation Act (COBRA) and Qualified Medical Child Support Orders (QMCSO) by assessing the validity of the orders, responding to the agencies timely, adding dependents, and tracking eligibility.

Communication with both internal and external customers and providing excellent customer service is vital for this role. Account Representatives are responsible for responding to inquiries from the Customer Service Department and the Claims Department regarding member eligibility. Additionally, Account Representatives communicate with other internal departments regarding escalated eligibility issues. Account Representatives are responsible for managing their accounts, which includes daily communication with employers regarding work reports, payments, eligibility, and new hires and terminations. Partnering with the Audit and Legal Departments is also critical for this role, as Account Representatives are expected to have full understanding of the provisions provided in the contracts, SPDs, and CBAs.

ESSENTIAL JOB FUNCTIONS AND DUTIES

• Process and monitors employer reports and refers late employers to the Legal Department
• Verifies employer payments in US Bank to ensure all payments are processed timely.
• Applies credits and debits accurately in the eligibility system.
• Updates participants file in the eligibility system timely with work report information for terminated and new hire employee information. This prevents problems with participants/dependents who have qualified for health care coverage.
• Partners with vendors to update urgent eligibility requests.
• Escalates recurring issues that delay eligibility to management.
• Maintains and monitors employee elections and related co-premiums.
• Maintains, monitors and reviews proof documents (marriage certificates, divorce decrees, birth certificates, etc.) for dependent coverage and related contributions.
• Monitors outstanding balances and notifies employers of monthly discrepancies through written correspondence.
• Notifies participants of payment discrepancies and cancellations through written correspondence
• Reviews the weekly and monthly COBRA & Health Insurance Portability and Accountability Act (HIPAA) eligibility list for his or her accounts to ensure accuracy of qualifying events.
• Determines if the participant’s plan provides access to dependent coverage, and meets the requirements of the QMCSO
• Maintains all QMCSO and COBRA/HIPAA files, including enrollment and payment documents.
• Updates appropriate systems to track compliance and ensures that coverage is provided in accordance with the terms of the QMCSO
• Provides exceptional customer service
• Set goals and achieve measurable results.
• Contributes ideas for process improvement and achieving department goals.
• Exemplifies the Fund’s BETTER Values and Professional Effectiveness Dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion

ESSENTIAL QUALIFICATIONS

• 1 ~ 3 years of related experience
• Working knowledge and experience in accounting, medical insurance, eligibility billing, delinquency procedures, reconciliation of payments, and collections
• Preferable experience in accounting/banking, eligibility rules including COBRA and Health Insurance Portability and Accountability Act (HIPAA), Employee Retirement Income Security Act (ERISA), and an understanding of Collective Bargaining Agreements
• High school diploma, minimally
• Intermediate level Microsoft Office skills (Excel, PowerPoint, Word, Outlook)

Salary range for this position: Hourly $20.3589 - $24.9743. Actual hourly rate may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a hybrid work-from-home arrangement.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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