Blue Cross Blue Shield of Michigan

Specialty Billing Representative I

Blue Cross Blue Shield of Michigan  •  Lansing, MI (Onsite)  •  4 hours ago
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Job Description


Level I is in a learning capacity and will progress to the senior level when the incumbent qualifies and is
able to provide coverage and assistance across all primary responsibilities and focus areas
independently.


This job is primarily responsible for products and services underwritten by the Enterprise that require
manual processes due to the complex nature of the request or system limitations. Performs in-house
collection activity that ultimately determines financial resolution of delinquent funds owed to the
Enterprise. Services, bills and manages tasks related to “specialty” (i.e. Loss Sensitive, AccuPremium)
business underwritten by the Enterprise. Calculates commission owed to agencies on a monthly basis
and handles all servicing related to agency commissions. Contacts include: Enterprise employees,
agents and policyholders, external collection agencies, NCCI and legal representatives.


PRIMARY RESPONSIBILITIES:
• Maintains in-depth knowledge of policy and commission structure of each
brand within the Enterprise.
• Completes manual commission calculations for the individual brands within
the Enterprise. Creates statements and check requests to pay commissions
on a monthly basis.
• Manually calculates and bills for retrospective premium adjustments and
monthly losses related to loss sensitive business for all brands within the
Enterprise.
• Monitors and tracks collateral to ensure loss funds are adequately funded.
• Works directly with policyholders and external collection agencies in regards
to past due balances. Uses authority levels to make decisions in regards to
balances due.
• Monitors aging reports and completes follow-ups with Premium Audit,
Underwriting and Management.
• Reviews, negotiates and approves payment arrangements and settlement
offers on past due receivables for the Enterprise.
• Files bankruptcy claims with the Bankruptcy Court for policyholders that have
entered bankruptcy. Has an understanding of the different types of
bankruptcy and how to appropriately handle each.
• Participates in the development of requirements related to new Enterprisewide systems.
• Verifies reasonableness of data in ancillary and disparate systems.
• Reconciles accounts to clarify billing transactions and cash application in
order to provide customers with up-to-date account information/history.
• Responds to internal and external customer requests via telephone or
electronic correspondence. Correspondence is drafted as requested to
address complaints or information requests. Requests are initiated by
agents, policyholders, underwriters, or management.
• Processes pay by phone transactions to expedite posting of cash to insured’s
policy.

ADDITIONAL RESPONSIBILITIES FOR THE LEVEL II:
• Provides coverage and assistance across all primary responsibilities and focus areas.
• Provides training and mentoring to the Level 1 Specialty Billing Representative position.
• Addresses and responds to complex internal and external customer requests.
• Works with minimum supervision.
EMPLOYMENT QUALIFICATIONS:
A. EDUCATION REQUIRED: (Brief paragraph detailing the minimum education required, including
certifications) Do not state preferred qualifications.
Minimum of an Associates degree in Business or equivalent. Combinations of relevant education and
work experience may be considered in lieu of degree.


B. EXPERIENCE REQUIRED:
Minimum of three (3) years experience in billing, underwriting, policy processing or equivalent work
which provides the necessary skills, knowledge and abilities.


OR


Bachelor’s degree in Business or equivalent and 1 year of relevant experience in billing, underwriting
or policy processing. Combinations of relevant education and work experience may be considered in
lieu of degree.


ADDITIONAL EXPERIENCE REQUIRED FOR THE LEVEL II:
Minimum of five (5) years experience in billing, underwriting, policy processing or equivalent work
which provides the necessary skills, knowledge and abilities.


OR


Bachelor’s degree in Business and 3 years of relevant experience in billing, underwriting or policy
processing.


C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
• Basic knowledge of workers compensation.
• Knowledge of claims and underwriting operations (i.e. deductibles, billing etc.,)/
• Ability to analyze details of policy billing and payment data and, based on this analysis, make
efficient and effective independent decisions within authority.
• Ability to analyze details of policy billing and payment data and, based on this analysis, make
efficient and effective independent decisions within authority.
• Ability to manage multiple priorities and meet established deadlines.
• Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.
• Knowledge of insurance operations. Specifically as they pertain to state specific requirements.
• Excellent math skills. Ability to accurately interpret and analyze data.
• Ability to process transactions on multiple processing systems.
• Ability to use diplomacy, discretion and appropriate judgment when addressing callers.
• Requests write offs to resolve small balance and NSF fee discrepancies
within guidelines.
• Requests money moves to ensure accurate posting of cash.
• Maintains knowledge of state regulations as they pertain to movement of
funds between policies and legal entities.
• Maintains confidentiality of information processed
Re-allocatable to Level II
• Ability to proofread documents for accuracy of calculations.
• Excellent organizational skills and ability to prioritize work in order to meet strict deadlines.
• Excellent oral and written communication skills.
• Excellent analytical and problem solving skills.
• Knowledge of computers and ability to type 40 words per minute.
• Knowledge of word processing software.
• Basic knowledge of database software.
• Advanced knowledge of spreadsheet software.
• Ability to effectively exchange information clearly and concisely, reports facts and other
information and respond to questions as appropriate.
• Knowledge of policy and claim processing systems.


ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED for the LEVEL II:
• Knowledge of enterprise policy and commission structure.
• In-depth understanding of collateral structures and plans.
• Ability to interpret, analyze and bill a policy with minimal supervision.
• Knowledge of state specific collection regulations and laws.
• Knowledge of loss sensitive plans used by the enterprise; specifically, how balances related to
losses are calculated and invoiced.
• Knowledge and understanding of both underwriting and claims is obtained
• In-depth knowledge of insurance operations. Specifically as they pertain to state specific
requirements.
• Demonstrated knowledge to provide coverage and assistance across all primary responsibilities
referenced above.
• Ability to make decisions and work with minimal supervision.
• Ability to manage multiple priorities and meet established deadlines.


D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES
PREFERRED:
• Bachelor’s degree in Business
• Insurance education coursework.
• Knowledge of departmental procedures, workflows, and systems.
• Knowledge and experience of policy processing, claim and financial reporting systems.


WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards.

#BU

Blue Cross Blue Shield of Michigan

About Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan is a nonprofit corporation and an independent licensee of the Blue Cross and Blue Shield Association.

BCBSM's commitment to Michigan is what differentiates it from other health insurance companies doing business in the state. That mission has never changed. Nearly 70 years ago, Blue Cross Blue Shield of Michigan started with a purpose to provide people with the security of knowing they have health care when they need it.

Today, that nonprofit mission is the same and the company is accomplishing it in many ways, including:

Offering access to health care coverage for everyone, regardless of circumstances

Never dropping your coverage for health reasons

Partnering with the state to cover more than 32,000 children through MIChild

Providing financial support to 30 free clinics statewide

Contributing more money than any other company to provide Michigan with better health and health care

Advocating and educating through Alliance for Advancing Nonprofit Health Care

For more on the history of BCBSM, please visit our section on historical highlights: http://www.bcbsm.com/home/bcbsm/1930.shtml

Industry
Finance & Insurance
Company Size
10,000+ employees
Headquarters
Detroit, Michigan
Year Founded
Unknown
Website
bcbsm.com
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