Enrollment Processor, Intermediate

Your Role 

The IFP Install and CEC team support our consumer line of business by managing the eligibility and reconciliation of our IFP membership for both on and off-exchange membership. The Enrollment Processor, Intermediate will report to the Operations Supervisor, IFP Install. In this role you will review and reconcile eligibility data, support our vendor team with clarifications and work with internal and external stakeholders to ensure our IFP membership has accurate eligibility and rates.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work 

In this role, you will: 

• Regularly contact internal and external customers and business partners to verify or obtain additional information to complete processing work
• Verify accuracy of entered data against source documents
• Utilize multiple sources to verify and reconcile eligibility information
• Process group or member level enrollment, cancellations and changes
• Make decisions based on review of source documents for routine and difficult processing issues
• Work with internal and external stakeholders to align eligibility and address discrepancies
• Ability to communicate effectively with internal and external business partners 

Your Knowledge and Experience 

• Requires High School Diploma or GED
• Requires at least 3 years of prior relevant experience in Health Insurance (e.g., claims, customer service, processing)
• Knowledge of Covered California Eligibility guidelines and enrollment processing preferred
• Knowledge of Facets, SAS, Edifecs, PEGA, & CalHeers preferred
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, Power Point, and Word

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. 

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. 

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!  

Our Values: 

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. 
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. 

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail. 

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.