Lead Membership Specialist

Job Description

Facilitate the enrollment of groups and members and the maintenance of membership records for new and renewal business in systems of record. Engages with vendors to ensure work is processed timely and accurately in accordance with organizational SLA’s. Perform audits, analyze data and identify and create solutions for problems/trends. Foster strong relationships with internal and external stakeholders throughout the entire membership lifecycle.

What You'll Do

• Facilitates the maintenance of membership information by ensuring our vendors processes member enrollment, additions, deletions, and/or changes on all products and systems for complex groups and/or electronic groups.

• Supports moderate and high complexity group level enrollment for health and ancillary products.

• Identify, document, and report system and process problems/trends using root cause analysis and implements solutions for assigned pod.

• Resolves complex and sensitive issues related to the administration of eligibility of subscribers/members based on federal/state guidelines and external and internal governing agencies.

• Leads work for health and ancillary products within their pod, including setting up group and member records, scheduling the release of member ID cards, group contract(s) and invoices.

• Responsible for knowledge management activities within the assigned pod; i.e. documenting processes, desktop procedures, and delivering the applicable training to the vendor and less experienced team members.

• Conduct quality assurance peer audits and provide coaching/training as needed.

• Builds strong relationships with all customers to facilitate a strong group and member experience.

• Serve as a subject matter expert for less experienced department employees.

What You’ll Get 

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community

• Work-life balance, flexibility, and the autonomy to do great work  

• Medical, dental, and vision coverage along with numerous health and wellness programs

• Parental leave and support plus adoption and surrogacy assistance 

• Career development programs and tuition reimbursement for continued education 

• 401k match including an annual company contribution 

• Learn more   

What You Bring

• High school Diploma or GED and 5 years of member enrollment experience, or

• Bachelors degree and 3 years of member enrollment experience

Bonus Points

• Proven formal or informal leadership experience strongly preferred 

• Background in health insurance operations, benefits administration, or group administration

• Adaptability: Remains flexible and responsive in dynamic environments, adjusting priorities and approach based on changing business needs or new information

• Critical thinking and Problem-Solving: Track record of anticipating risks, addressing complex issues proactively, and making sound decisions under pressure while balancing people, process, and outcomes.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets,  licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer