Account Representative II

**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 II is responsible for processing complex enrollments and elections and applying monthly contributions from employees/employers based on the Summary Plan Document (SPD) and Collective Bargaining Agreement. This is essential for providing participants with eligibility for health care coverage. This also includes reconciling monthly work reports and processing applications for Consolidated Omnibus Budget Reconciliation Act (COBRA) and processing and applying cash from participants. This position will process Qualified Medical Child Support Orders (QMCSO) by assessing the validity of the orders, responding to the agencies timely, adding dependents, and tracking eligibility. This level handles a case load with increasing complexity, which includes intermediate hybrid and contribution plans, self-pay plans, and plans that include the processing of FMLA and vacation hours with minimal supervision. This level also runs basic queries/reports, conducts basic regression testing, and sets up new employer groups. Account Representative Level II employees are responsible for training employees on the self-service portal (ESS) and have a basic understanding of health and welfare benefits. Communication with both external and internal 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 Regional Directors 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. Partnering with the Audit and Legal Departments is also critical for this role, as Account Representative are expected to have full understanding of the provisions provided in the contracts, Summary Plan Documents, and Collective Bargaining Agreements. # ESSENTIAL JOB FUNCTIONS AND DUTIES # - Determines if the participant’s plan provides access to dependent coverage, and meets the requirements of the QMCSO - Ensures eligibility is updated timely to prevent problems with participants/dependents coverage seeking care - Partners with vendors to update urgent eligibility requests - Escalates recurring issues that delay eligibility to management - Applies credits and debits accurately in system - Maintains all QMCSO and COBRA/HIPAA files, including enrollment and payment documents - 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 - Updating participants file in the eligibility system with terminated employees and new hire information - Verify employer payments in US Bank to ensure all payments are processed and follows up with employers on any unprocessed payments - Monitors employer reports and refers late employers to the Legal Department - 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 - Updates appropriate systems to track compliance and ensures that coverage is…