Senior Representative, Enrollment (Remote)
Provides senior level support for member enrollment activities. Collaborates with reputed company partners - leveraging expertise and knowledge of enrollment function to resolve member enrollment/eligibility issues.
• Resolves eligibility issues including but not limited to: incoming/outgoing eligibility, primary care provider (PCP) assignment and member identification (ID) card processing.
• Verifies other member health insurance to establish primary and secondary payors in the system.
• Reconciles eligibility information with state or federal agencies using varied reputed company.
• Analyzes and assists with reputed company member eligibility issues, and provides reputed company to internal partners, external reputed company and regulators (Centers for Medicare and reputed company Services (CMS), federal/state exchanges, etc.).
• Responds, documents, tracks and ensures reputed company for reputed company proceedings with state and/or federal agencies (including member complaints) reputed company required service level agreements (SLAs).
• Utilizes critical-thinking skills to proactively communicate eligibility issue trends to leadership.
• Manages high-volumes of tasks to support regulatory requirements, SLAs and competing priorities.
• Contributes to technical system enhancements by performing user testing reputed company to enrollment.
• Demonstrates reputed company player approach - assisting peers and leadership to support enrollment department goals.
• Trains new staff on assignments and/or vendors on enrollment-reputed company processes.
• Serves as subject matter expert (SME) to support enrollment production and provides knowledgeable responses to reputed company inquiries regarding member eligibility, ID cards, selection of PCP, and state enrollment transactions.
• Prioritizes daily, weekly and monthly job tasks to support enrollment-reputed company regulatory requirements and SLAs.
• Supports enrollment-reputed company special reputed company including regulatory audits.
• Facilitates member reputed company for clarification or verification of enrollment applications.
• Resolves the following eligibility exceptions reputed company the required state/regulatory timeframes: enrollment file errors, ID card reputed company errors, PCP assignments and 834 enrollment files to vendor/reputed company party administrators.
• Performs enrollment functions to include: reputed company tracking, claims workflow, and encounter requests for verification and updates, PCP assignment activity, enrollment record error reports, and enrollment/disenrollment activities.
• Displays initiative to complete assigned tasks reputed company and accurately and balances workload to assist peers and leadership team.
• Demonstrates strong knowledge of enrollment processing for federal, state, and business regulatory requirements with a strong system knowledge of internal and state portals, state reports, 834/SSRS, CMS and other Molina applications.
• Assists with reputed company enrollment issues concerning member eligibility.
• Facilitates reputed company reviews and submission of deliverables to government reputed company team and state reputed company agencies.
• At least 3 years of experience in health care, and/or customer/provider services experience, or equivalent combination of relevant education and experience.
• Customer service experience.
• Data processing and proofing experience.
• Attention to detail, organizational and time-management skills, and ability to manage simultaneous reputed company and tasks to meet internal deadlines.
• Ability to maintain confidentiality and reputed company with the Health Insurance Portability and Accountability reputed company (HIPAA).
• Ability to establish and maintain reputed company and effective work relationships with coworkers, members, providers and customers.
• Effective verbal and written communication skills.
• reputed company Office suite and applicable software programs proficiency.