Coordination of Benefit Representative - Hybrid in Orange County, CA

About the role

This position is hybrid in Orange County, CA. The Coordination of Benefit Representative assists in the day-to-day responsibilities of the various sections within the Membership Unit. The Representative ensures that all of the COB and MSP files from CMS are properly loaded in EZ-Member, as well as coordinating benefits between AHP and other coverage.

Responsibilities

• Uploads daily files from CMS into EZ-Member.
• Updates and deletes members' other coverage through COB contractor via ECRS.
• Ensures members' files are flagged with the proper coverage (primary or secondary).
• Ensures all COB data is transferred into EZ-Cap.
• Responsible for surveying current members with other coverage on a yearly basis as well as new members.
• Collaborates with I.T. on creating reports and any system updates as per CMS guidelines.
• Collaborates with the Claims Department on other coverage discrepancies or updates.
• Contacts other insurances to verify members’ coverage or members to obtain proof of coverage.
• Updates COB/MSP policy and standard operation procedures (SOP) as needed.
• Collaborates with the Eligibility Department on coverage discrepancies.
• Assists in the day-to-day activities for any section within the Membership Unit, including filing, typing, data entry, and mailing communications to members.
• Handles outbound calls, sending facsimiles, and/or email communications.
• Assists in processing the Weekly Transaction Reply Report (TRR) and Monthly TRR.
• Mails weekly and monthly notification letters to members and ensures proper documentation is added in EZ-Member.
• Other duties as assigned.

Requirements

• Minimum 3 years of direct customer service experience.
• Minimum one year of direct sales or related experience.
• High School Diploma or GED.
• Basic knowledge of Medi-Cal and Medicare Advantage Prescription Drug Plans.
• Familiarity with CMS MMR and TRR files.
• Basic computer skills, including Microsoft Outlook, Excel, and Word.
• 40 WPM typing speed.
• 10-Key by touch.
• Direct handling and processing of CMS enrollments and disenrollment applications.
• Ability to communicate positively, professionally, and effectively with others; provide leadership, teach, and collaborate.

Skills

• Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence.
• Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
• Problem-Solving Skills: Effective problem-solving, organizational, and time management skills, and ability to work in a fast-paced environment.
• Preferred: Bilingual (English/Spanish).

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions

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.

• Regularly required to sit; use hands to finger, handle, or feel; and talk or hear.
• Frequently required to walk; stand; reach with hands and arms.
• Occasionally required to climb or balance; stoop, kneel, crouch, or crawl.
• Occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Pay

Pay Range: $41,600.00 - $57,600.00. Pay range may be based on a number of factors including market location, education, responsibilities, and experience.