Account Service Consultant I/II (Buffalo/WNY Region) (Finance)

Job Description:

Job Description

Based on the territory associated with this role, candidates must reside in our Western NY service area (consisting of Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties)

Summary:

This role ensures prompt, accurate, and efficient service for all inquiries from brokers, consultants, members, and group administrators across all product lines. The Account Service Consultant (ASC) handles inquiries received through various channels, including telephone, email, written communication, and in-person visits, whether in the office or on-site with brokers, consultants, or employer groups.

The ASC maintains consistent communication with the Sales team, providing valuable information and insights to group accounts. They are responsible for implementing new groups, renewing and converting groups to new product lines, and working closely with Operations, Customer Care, Claims, and Finance/Underwriting departments to support group implementations and address account-related issues.

In partnership with assigned account managers, the ASC supports the retention and growth of existing business, ensuring positive account relationships. This role assists in preparing proposals, meeting materials, and sales collateral during the account renewal process. The incumbent also evaluates, recommends, and implements processes to meet account objectives, serving as the liaison between group administrators and internal departments to facilitate problem resolution.

Essential Accountabilities:

Level I

• Researches, interprets, and responds to inquiries from internal and external customers, business partners, brokers, consultants, and groups concerning our products, services, and policies in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements.
• Responds to sales/retention team requests for assistance in the field and provide support where needed regarding new and existing business activity to include completion of group information.
• Assists with the development and implementation of new groups or converted groups as directed. Manages group implementations and supports enrollment meetings.
• Acts as a liaison between the group/broker/consultant and internal departments when it comes to new group implementations, renewals, escalations, reviews, and daily support.
• Identifies and responds to issues as brought forward either internally or externally and ensures all inquiries will be responded to within 48 hours and in most cases resolved. Assists with escalated issues that may surface within a day.
• Assures that all account data is maintained on a timely and accurate basis such as initial account setup, benefit books, summaries, contracts, etc.
• Services brokers, consultants, and employer groups supporting a mix of pre-packaged material as well as custom benefits.
• Responsible for custom, complicated employer groups servicing.
• Manages any de-implementations associated with a complex group that terminates from our portfolio when applicable.
• Reviews all group-facing documents and validates for accuracy. This can include, but is not limited to, benefit summaries, summary plan descriptions, Member Contracts, Group Agreements, etc.
• Partners with Project Management team to support vendor relationships and conversations related to electronic enrollment methods for assigned book of business.
• Researches complex billing issues, including online bill pay issues and group payment issues.
• Reaches out to groups and brokers for delinquent groups on the monthly group cancel list.
• Responsible for member enrollment and coverage updates. Creates custom enrollment applications for groups. Creates open enrollment books upon a group's renewal.
• Researches ANSI weekly enrollment file issues.
• Troubleshoots online access issues for a group or broker.
• Researches member claim issues when an employer group, member, or broker reaches out.
• Monitors sales queue phone line calls from groups and brokers and researches associated issues.
• Manages wellness rewards calls and addresses wellness rewards issues.
• Generate and provide local participating provider reports.
• Assist with the completion of provider disruption reports when new requests for proposals are sent to the sales division.
• Post group renewal benefit review and validations.
• Attends provided/necessary training to support job role/function and attends meetings as necessary to disseminate information to the Sales and the Account Service staff.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

• Acts as the go-to person along with other Account Service Consultants to coordinate daily activities when necessary.
• Assists in the maintenance of files, records, reports and operating manuals.
• Assists in obtaining financial, utilization and ad hoc reports as requested.
• Creates and delivers presentations to external customers.
• May train new staff.

Level III (in addition to Level II Accountabilities)

• Identifies issues, patterns and/or trends generated by external and internal action affecting customer satisfaction and consistently and independently recommends and initiates changes and improvement.
• Attends meetings and/or trainings as a representative of the Account Service Team and shares the information learned with the Account Service Staff within a reasonable period.
• Handles HIPAA (Health Information Portability and Accountability Act) issues as requested by members through Group Administrators. Specifically, handles all Designated Record Set (DRS) requests and may serve as a point person for the Account Service team when difficulties arise in obtaining information through normal channels.
• Acts as a backup to Account Manager when individual is out of the office.
• Assists with on-the-job training of other Account Service and Sales Associates as requested.
• May create rate requests for proposals.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

• Two or more years of experience in service or healthcare industries or Associate's degree in related field with a minimum of one-year relative work experience .
• Valid NYS Life, Accident and Health license within six months of employment required and ongoing completion of Continuing Education requirements. Incumbent will be ineligible for incentive compensation until license is received.
• Must complete required internal Medicare Training per Center for Medicare Services within one year of start date.
• Knowledge of NYS and Federal regulations and underwriting policies and all process flows.
• Knowledge of operating systems.
• Strong oral and written communication skills.
• Excellent computer skills required, including the ability to navigate in a Windows environment, database functions, and any sales force automation software applications.
• Demonstrated expertise in problem-solving skills necessary to resolve customer inquiries accurately and efficiently, in an organized manner, resulting in superior accuracy and production levels and retention of subscriber contracts.
• Proven ability to maintain a professional and courteous attitude towards co-workers, internal and external customers, and represent the Health Plan, its products, policies, and procedures in a positive and professional manner.
• Skillful at working between multiple programs and applications simultaneously.
• Ability to maintain effective working relationships across the organization.

Level Il - in addition to requirements above:

• Two or more years of relevant experience working in Account Sales/Service/Broker environment.
• Thorough knowledge and expertise of benefit programs for all Health Plan business required.
• Proven ability to efficiently resolve complex and escalated issues with minimal direction.
• Proficiency in Microsoft Office Suite, with exceptional navigation and system skills. Ability to quickly adapt to and master all company specific platforms and tools.
• Exceptional communication skills across multiple channels including, but not limited to, voicemail, email, and outbound calls.
• Thorough understanding of organizational structures to expedite conflict resolution.
• Demonstrated accountability and ownership of issues and resolution with minimal supervision.
• Provides mentoring and support to new hires and peer group.

Level III - in addition to Level II requirements:

• Four or more years of relevant experience working in Account Sales/Service/Broker environment.
• Prior experience supervising or managing people and/or projects or indirectly leading teams.
• Thorough understanding of claims-based billing, diverse funding arrangements and captive group structures.
• Self-sufficient in resolving complex and escalated issues.
• Consistently trains other Account Service team members to initiate resolution to all outstanding and/or difficult issues.
• Assist with tasks assigned by management that require advanced problem-solving skills.

Physical Requirements:

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to travel as necessary to offer support for on-site visits to groups/brokers, open enrollments, training and/or off- site meetings.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I (N5): Minimum: $20.02/hr - Maximum: $33.03/hr

Level II (N6): Minimum: $21.83/hr - Maximum: $34.92/hr

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.