Network Service Representative jobs in Honolulu, HI

POSITION SUMMARY

Under the supervision of the   Group Service Center Manager, maintains and supports the Enrollment Database with information provided by HDS clients and internal departments via manual or electronic means within the established performance standards.  Analyzes, researches, and resolves customer issues.  Assists the  Group Service Center Manager in ensuring company and departmental goals and objectives are met and work processes follow departmental policies and procedures.   Assists and supports the Group Service Center Team, in their absence, in performing duties related to eligibility transactions, employer portal access, and service center clerk workflow.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Key Responsibilities

• Understands the process of electronic and non-electronic eligibility files.   Thoroughly understands the relationships between the HDS’s eligibility database, the electronic eligibility application and client file format to assure accurate processing of the client file. Responsible for analyzing and validating key discrepancies, determines the appropriate action to accurately apply the eligibility data into HDS’s eligibility database.   Works with the clients to resolve eligibility discrepancies identified during the processing of the eligibility data file.  Provides feedback to the Electronic Eligibility Administrator and   Group Service Center Manager for electronic eligibility system improvements. May assist in the set up and testing of new electronic eligibility file transmittals. 
• Develops and maintains high customer relations assisting clients with electronic eligibility processing, including HDS Online, and problem resolution. Services customers, internally and externally, and responds to inquiries regarding enrollment and eligibility utilizing a thorough understanding of company and departmental guidelines, policies and procedures, and system capabilities.
• Reviews and compares eligibility reports submitted by Third Party Administrators and enters new member enrollment, updates existing member files, and works with employer group administrators to maintain an accurate eligibility data file.   Communicates and works with the client to resolve eligibility discrepancies identified during the processing of the eligibility report. Reviews and applies HDS’s policies and enrollment guidelines when entering new member enrollment and updating existing member files for the Individual Dental Plans including On-exchange Market Plans.
• Assists in the administration of HDS Online enrollment services, including but not limited to, new online access account set up and customer support. Promotes and assists groups with HDS Online products and services for Employer Groups.  Educates customers on advantages and supports users on the understanding of system capabilities. Assists ITS with testing during upgrade processes.  
• Proactive in identifying opportunities for operational, systems and process improvements and makes recommendations to the  Group Service Center Manager to improve the efficiencies and effectiveness of services provided by the department.
• Performs and adheres to the established Documents Retention Policies by performing imaging of eligibility transaction documentation for reference.

Other Duties and Responsibilities

• Develops and maintains positive relationships with group administrators, Third Party Administrators and Trust Funds to effectively apply eligibility changes submitted to HDS.
• Adheres to established company and departmental policies and procedures, HIPAA regulations and documents retention policies.
• Assists in processing manual eligibility changes as necessary during high volume periods or periods of low staffing.
• Periodically reviews various data reports such as Over Extended COBRA Coverage, Missing Eligibility Contact, etc. and update information accordingly.
• Communicates internally and externally in a professional manner via phone, email, or written correspondence. 
• Completes routine administrative tasks.
• Provides support to other departments such as Sales,  Dental Claims, Billing, and the Service Center Clerks as needed. 

MINIMUM QUALIFICATIONS AND EXPERIENCE

Education

Associate’s degree in business administration or an equivalent combination of education, training or experience that has equipped the applicant with the necessary knowledge, skills, and abilities to successfully perform the duties of this position.

Experience 

Two years progressively responsible office administration experience, preferably in the areas of servicing groups, group contracts and/or customer service.

Skills and Knowledge

• Ability to organize, analyze and problem-solve complex problems.
• Ability to handle multiple tasks and prioritize with some distractions.
• Ability to communicate both orally and in writing with all levels of staff, customers, consultants/brokers, and vendors on sensitive matters.
• Technical knowledge and experience with using computer applications for problem-solving and answering staff questions (prefer Windows, and Word).
• Ability to focus on detail.
• Ability to handle all information in a confidential manner and in compliance with federal and state laws/regulations (i.e., HIPAA, PHI).

Note: The above information in this description has been designed to indicate the general nature and level of work performed by an employee in this classification.  It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job.  Hawaii Dental Service has the right to add to, revise, or delete information in this description.  Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.