Delta Dental of Wisconsin is seeking a Billing & Enrollment Exchange Specialist to support our Federal and State Exchange business. This role is responsible for the accurate and timely processing of electronic enrollment files, submission of reconciliation files, resolution of enrollment-related issues, and serving as a key liaison with Federal and State-Based Exchanges.
This is an excellent opportunity to expand your skills, gain cross-functional experience, and position yourself for future promotional opportunities within our organization. We offer a collaborative work environment, comprehensive benefits, and ongoing professional development opportunities.
Delta Dental of Wisconsin offers a competitive and comprehensive benefits package, including:
- Medical and dental insurance
- 401(k) retirement plan with employer match
- Generous Paid Time Off (PTO) program
- Professional development and cross-training opportunities
- Career growth and advancement potential
The Billing & Enrollment Exchange Specialist is responsible for administering enrollment and billing processes associated with Federal and State Health Insurance Exchanges. This role ensures the integrity and accuracy of Electronic Data Interchange (EDI) enrollment transactions, resolves complex enrollment and billing issues, performs reconciliations, and serves as a Subject Matter Expert (SME) for exchange-related processes.
- Process enrollment files received through electronic data feeds and perform account maintenance activities.
- Conduct data reconciliation to ensure accuracy and consistency of information exchanged through EDI in accordance with Federal and State Exchange guidelines.
- Monitor, investigate, and respond to inquiries and escalations from Federal and State Exchanges.
- Submit and reconcile inbound enrollment reconciliation files.
- Create, update, and maintain comprehensive documentation related to exchange processes, procedures, and system changes.
- Establish and maintain EDI procedures and promote best practices across the department.
- Participate in Federal and State Exchange meetings and communicate required operational changes.
- Serve as a Subject Matter Expert (SME) and escalation resource for EDI enrollment and billing issues.
- Ensure the accurate application of Advance Premium Tax Credits (APTC) and individual consumer premium payments.
- Reconcile APTC activity and confirm policies are billed at the appropriate premium rates.
- Perform User Acceptance Testing (UAT) for system enhancements, process improvements, and new exchange-related initiatives.
- Collaborate with internal teams and external business partners to ensure successful file submissions, error resolution, and process improvements.
- Identify, communicate, and escalate critical issues to appropriate stakeholders.
- Partner with Client Experience and Product Services teams regarding client impacts resulting from Federal or State Exchange changes.
- Participate in team meetings, training sessions, and special projects as assigned.
- Maintain knowledge of Wyssta policy processing agreements and client requirements.
- Provide exceptional customer service and respond professionally to enrollment and billing inquiries received via phone, email, web, or other communication channels.
- Strong analytical, problem-solving, and troubleshooting abilities.
- Intermediate proficiency in Microsoft Office applications, particularly Excel.
- Excellent verbal and written communication skills with the ability to explain technical concepts to non-technical audiences.
- Strong organizational skills and attention to detail.
- Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.
- Self-motivated with the ability to work independently and collaboratively.
- Strong customer service orientation and commitment to quality.
- Associate degree in Business, Information Systems, Healthcare Administration, or a related field.
- 1–2 years of Electronic Data Interchange (EDI), enrollment, billing, insurance operations, or related experience.
- Experience working with health insurance exchanges, enrollment reconciliation, or premium billing processes.
You are detail-oriented, analytical, and thrive on solving complex issues. You enjoy working across teams, managing data integrity, and delivering outstanding service to internal and external customers. You take ownership of your work, communicate effectively, and continuously seek opportunities to improve processes and outcomes.
Ready to build your career with Delta Dental of Wisconsin? Apply today and become part of a team committed to improving oral health and delivering exceptional service to our members and partners.
