Enrollment and Billing Specialist

SUMMARY

Performs moderately advanced benefits program administration and member assistance work. Work involves determining benefits eligibility, processing applications for benefits, and providing guidance to Benefit Coordinators with benefits eligibility inquiries. Works under moderate supervision, with some latitude for the use of initiative and independent judgment. The ideal candidate for this position will have a comprehensive understanding of employee benefits, strong problem-solving skills, excellent verbal and written communication skills, a commitment to customer service, enjoy interacting with people, and be comfortable working in a fast-paced and structured environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES may include the following. Other duties may be assigned:

• Answers incoming inquiries (e.g. phone calls, emails, etc.) from Benefit and Billing Coordinators regarding benefit administration, eligibility, billing, and any other questions regarding employee benefits.
• Contacts benefit coordinators to resolve potential issues that have been identified internally.
• Clearly documents case activities, outcomes, and feedback received by members.
• Proactively handles own caseload and shared work queues to ensure timely resolution of escalated issues while meeting service levels and quality standards.
• Processes changes to employee and dependent TXHB offered benefits, demographics, and beneficiary information.
• Builds effective working relationships with Benefit Coordinators and others at assigned groups.
• Serves as a resource for Benefit Coordinators, guiding and mentoring them regarding TXHB benefit administration processes, policies, and procedures.
• Conducts basic data reviews of cases and inquiries to identify recurring issues, knowledge gaps, or process breakdowns and recommends potential solutions to leadership.
• Proactively identifies and reaches out to Benefit Coordinators to discuss ongoing benefits or eligibility trends related to individual group benefit administration challenges.
• Collaborates with other internal teams and external vendors to resolve eligibility and billing questions or issues.
• Provide direction to peers by assisting with trainings as directed by Supervisor.
• Participates on cross‑functional project teams focused on implementing new clients, systems, or benefit programs by representing the advocate perspective and validating processes.
• May review and provide feedback on AI-generated responses provided to group contacts.
• May serve as a backup for cross‑departmental work, including supporting special projects, documenting and testing new or updated processes, assisting with trainings, and contributing to operational readiness activities during peak periods or program changes.

KNOWLEDGE/SKILLS/ABILITIES

• Strong knowledge of eligibility requirements including Section 125 and COBRA rules.
• Strong knowledge of MS Office and billing and enrollment software.
• Strong problem-solving and research skills
• Ability to effectively communicate complex benefits administration subjects both verbally and in writing.
• Effective time management, organization, and prioritization skills.
• Advanced knowledge of TXHB products, benefit terminology, benefits design, and eligibility rules.
• Ability to work in a team environment and perform multi-task job functions.
• Strong service-oriented communication skills, including the ability to empathize with others and diffuse tense situations when needed.
• Ability to convey a professional manner in dealing with others and maintain constructive working relationships.
• Self-motivated to fulfill tasks, resolve issues promptly, and meet deadlines.
• Ability to effectively work within rapidly changing circumstances as needed.

EDUCATION/EXPERIENCE

• 1-2 years of work experience in a related field such as Human Resources or health insurance
• Graduation from an accredited four-year college or university with major coursework in business administration, insurance, or a related field is preferred. 
• Experience working in a service-oriented position, where customer satisfaction is a key performance indicator is preferred.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to speak/hear clearly to communicate by phone or in person.
• Ability to frequently stand, sit and walk.
• Ability to frequently lift and/or move up to 15 pounds. 
• Prolonged periods of sitting at a desk and working on a computer.

Flexible Work Arrangements

☒ 100% Remote (MON- FRI)

Work Schedule

☒ 8:00 AM - 5:00 PM (MON- FRI)