CareFirst Careers

Broker Contract Compliance Specialist

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Resp & Qualifications

PRINCIPAL ACCOUNTABILITIES - may include, but not limited to the following:

1. Review and analyze documentation submitted by Broker, FSP, GP or Direct Broker to determine appropriate course of action. Provide timely and accurate processing of all Broker of Record (BOR), Block Transfers and Broker/Agent Agreements for Group and Consumer Direct business.  Analyze each Broker/Agent’s block of business to determine and identify all groups associated with the broker/agent. Coordinate with Benefitfocus team regarding any 51-199 group business and other matters pertaining to electronic enrollment. Check billing entity to verify payment status prior to BOR approvals. Attend weekly SOCS conference calls to track Account Executive activity for BOR approvals, updates, and errors for the over 50 BOR changes, to avoid duplicate payment and ensure timely changes. Verify, research, and update Account Manager Book of business as applicable to ensure accurate notification of BOR changes. Provides professional, accurate and timely responses to requests and or inquires from internal and external customers.  Update completed work daily into SharePoint to track and trend department inventory as required by Management.  Apply independent analysis and critical thinking to research and resolve issues with commissions withheld for brokers and FSP/GP in order to understand department financial repercussions when accuracy is not achieved.  Compose written correspondence for customers regarding all transfers and maintain adherence to unit SOPs.

2. Update broker data into nomoreforms appointment website; Update Facets system with BOR/Block Transfer data for accounts going through a Broker, FSP, GP or Direct Broker.  Enter data in various systems; nomoreforms, Facets, TrueProducer, and Salesforce with  accuracy for internal unit tracking for BOR/Block Transfer work, and accurate transmission of broker/agent agreement data to all affected downstream systems.  Track and scan all approved Broker/Agent Agreements and input broker data into TrueProducer. Verify broker's health licenses and appointments within various State jurisdictions via their web sites. Approve agent E&O applications on MGA Insurance websites, and ensure all E&O certificates meet Risk management requirements. Research and conduct audit review of broker data for credentialing requirements for Broker Accounting to ensure accurate processing of broker commissions, and support certain aspects of the Broker Distribution Contracting responsibilities. 

3. Provide full range of support for Broker Sales Representatives on issues pertaining to their accounts. Respond to routine and management-requested adhoc reports to support Standard Operating Procedures (SOP) for Broker of Record Transfers, Block Transfers, Broker/Agent Agreement processing and agent licensing, insurance and appointment status.  Serve as point of contact for documentation verification required for various State audits and provide immediate feedback after completing review.  Follow work flows and SOP’s, for the functions of contracting, compliance, and transfers, including detailed coordination with counterpart(s).  Attend conference calls and meetings Share point of view and input on best practices and process improvement for Divisional operations. Ensure that all contracting and BOR/Block transfer documentation is save on the shared drive to maintain accurate record keeping. Provide issue resolution and support to external vendors by analyzing issues pertaining to withheld commissions, and access to downstream system caused by credentialing problems. Support senior management with summarized information to assist with high level decisions.

4. Other duties as assigned.   


QUALIFICATION REQUIREMENTS

Education:
Bachelor’s degree or equivalent .  Professional work experience will  be considered.

Experience:
Up to one year of client and broker communication and  interaction experience. Possess exemplary customer service, training skills, and keen decision-making.  Experience with using and applying mainframe systems data, underwriting guidelines, jurisdiction/State-mandated legislation, and regulations related to Small Group and Broker-related health care marketing and sales.

Preferred: 2-3 years in a customer service environment with experience in health insurance/managed care industry.

Skills and Abilities:

  • Strong inter-personal and teaming skills
  • High level analytical and statistical ability required to resolve spreadsheet report issues
  • Mid to advanced level spreadsheet skills and database applications
  • Strong organizational and time management skills; ability to work in a fast-paced environment.
  • Ability to interact effectively with people at different organizational levels, both internally and externally
  • Analytical and problem solving skills;
  • Written and oral communication skills
  • Ability to work and make decisions independently and with a team
  • Effectively handle frequently changing priorities, deadlines,  and  workloads that can be variable for long periods of time.  Prioritize and escalate issues and tasks as appropriate
  • Must be able to meet established deadlines and handle multiple customer service demands  from internal and external customers, within set expectations for service excellence.
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.


Technical Skills:

  • General-user knowledge of Carefirst, Inc. mainframe systems and others as corporate growth requires.
  • Intermediate skills with Carefirst, Inc. supported PC-based software applications.
  • General knowledge of Carefirst, Inc. products and others as corporate growth requires.
  • General knowledge of agent appointments, licensing and other related health insurance laws and regulations.

Department

Department: Broker Relations

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 4/16/2018

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential job duties and responsibilities of the position.  Requirements may be modified to accommodate individuals with disabilities.

The employee is primarily seated while performing the duties of the position.  Occasional walking, standing, bending and driving are required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The employee must frequently talk and hear; sight is required.  Weights of up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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