Emory University is a leading research university that fosters excellence and attracts world-class talent to innovate today and prepare leaders for the future. We welcome candidates who can contribute to the diversity and excellence of our academic community.
The Senior EUSHIP (Emory Student Health Insurance Plan) Insurance Specialist will prioritize customer service and provide direction to policyholder questions or clarifications for policyholders seeking care in Student Health Services. Alongside communications management, response, and tracking, will work alongside and report to the Direct of Insurance to ensure longevity of communications processes and protocol for internal and external stakeholders.
JOB DESCRIPTION:
Assists in supporting the self-insured Emory Student Health Insurance Plan for enrolled students and dependents. Experience with creating spreadsheets, queries and database management are required to manage the insurance waiver and enrollment processes for eligible students. Reconciles weekly and monthly enrollment, claims and utilization reports with internal and external partners, as needed. Collects and interprets raw claims data and translates it into an actionable format to assess ongoing plan performance. Participates in annual plan renewals for the Emory student health insurance plan. Works closely with the Third-Party Administrator (TPA) and case management teams. Assists and/or performs fiscal year end reconciliation with the TPA to determine enrollment, utilization and claims outcomes. Reconciles weekly enrollment reports with the TPA. Will be a resource for assigned projects by the Director of Insurance. Participates in new student and program orientations. Responsibilities: Responsible for timely resolution and prioritization of customer questions including payment, referrals, claims, internal logistics and billing. Monitors EUSHIP elections through queries and reports to ensure compliance with applicable regulations and guidelines. Audits error reports on timely cadence based on urgency (weekly, monthly, quarterly & annually), and makes corrections as needed. Ensures related OPUS and PnC documentation is complete and accurate. Acts as a facilitator/connector and liaison between program administration, financial aid, student enrollment, TPA, and students & parents. Direct partnership work with TPA for customer service follow-up and other needs expected; understands and guides internal department needs for policyholders within their subgroup/purview. Contributes to the development or improvement of established procedures. Researches communication, operational, enrollment, payment, and claims history related to students and EUSHIP use. Growth opportunities as a subject matter expert in presentations and internal alignment work based on performance. Hires, supervises, trains, and evaluates a small customer service staff. Investigates issues created by QLE events and enrollment rules in OPUS & PnC, identifies problems, and works with OPUS team to test and update rules. Performs other related duties as required. MINIMUM QUALIFICATIONS:
A high school diploma or equivalent, and five years of hands-on healthcare experience in a managed care or insurance setting. Proficient with Microsoft Office applications including Microsoft Word, Excel and Outlook. Proficient with medical terminology. Experience with Electronic Medical Records, bonus for EPIC and Point and Click. A bachelor's degree is preferred. NOTE: Position tasks are generally required to be performed in-person at an Emory University location. Remote work from home day options may be granted at department discretion. Emory reserves the right to change remote work status with notice to employee.
Emory University is dedicated to providing equal opportunities and equal access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, and veteran's status. Emory University does not discriminate in admissions, educational programs, or employment on the basis of any factor stated above or prohibited under applicable law. Students, faculty, and staff are assured of participation in University programs and in the use of facilities without such discrimination. Emory University complies with Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veteran's Readjustment Assistance Act, and applicable executive orders, federal and state regulations regarding nondiscrimination, equal opportunity and affirmative action. Emory University is committed to achieving a diverse workforce through application of its affirmative action, equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. Inquiries regarding this policy should be directed to the Emory University Department of Equity and Inclusion, 201 Dowman Drive, Administration Building, Atlanta, GA 30322.
Emory University is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Department of Accessibility Services at (V) | (TDD). Please note that one week advance notice is preferred.
