City/State

Work Shift

Overview:

Sentara Health Plans is recruiting for an Other Health Insurance (OHI) Associate - Remote!

Status: Full-Time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F.

Location: Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming 

Job Description Summary:

Other Health Insurance (OHI) Associate is responsible for researching, verifying, maintaining, and updating member Other Health Insurance (OHI) information to ensure accurate coordination of benefits, claims processing, and enrollment records. 

Primary Responsibilities 

• Research, verify, and update member OHI information. 

• Validate OHI for Sentara Commercial, Medicare, and Medicaid members. 

• Determine the Payer Order between coverages. 

• Investigate OHI inquiries. 

• Complete assigned work queues within SLA requirements. 

• Participate in user training and knowledge share sessions, and retain and apply  

Education:

• High School Diploma or GED REQUIRED

Experience:

• 2 years of Health Plan Claims Disbursements REQUIRED

Preferred Qualifications 

• Knowledge of OHI Businesses. 

• Experience in insurance, enrollment, claims, customer service, or data-entry experience. 

• Proficiency with Microsoft Office products -

• Strong attention to detail and problem-solving skills. 

• Experience with QNXT, Facets, CSC, or similar healthcare systems. 

• Healthcare payer or managed care experience. 

Knowledge, Skills, and Abilities 

• Healthcare insurance knowledge 

• Data integrity and accuracy focus 

• Critical thinking skills 

• Attention to Detail 

• Accuracy and Timeliness 

• Strong communication skills with the ability to engage on phone calls for research and resolution of OHI inquiries 

• Communicate complex information clearly and concisely. 

• Ability to work independently and take ownership of assigned work 

• Ability to work collaboratively with team members for their shared goals 

• Ability to manage multiple priorities 

• HIPAA Compliance 

• Ability to follow SOP and Job Aids and apply them. 

Performance Indicators 

• Accuracy of OHI updates 

• Timely completion of work 

• Compliance with procedures 

• Support of data quality initiatives 

• Maintaining Productivity Targets

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. 

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-102496

Talroo-Health Plan

Healthcare, Health Pan, Health Insurance, Managed Care, MCO, Salesforce, QNXT, Other Health Insurance (OHI), Claims, Disbursements, Facets, CSC, enrollment, customer service, data-entry experience

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.