Enrollment Representative (51648)

Essential Job Functions

• Verifies enrollment status, makes changes to records, research, and resolves enrollment system rejections.
• Addresses a variety of enrollment questions and/or concerns received by phone or mail.
• Ensures accuracy and timeliness of the membership and billing function.
• Responds to inquiries concerning enrollment processes.
• Determines eligibility and applies contract language for each case assigned.
• Performs error output resolution for eligibility and processes error discrepancy list.
• Bills, collects premiums, and reconciles payments.
• Completes numerous data entry elements, including creating and maintaining membership records.
• Reviews workflows related to daily and weekly enrollment incremental files, Election forms, and Master File maintenance to provide complete membership records.
• Develops and maintains positive customer relations and coordinates with various functions within the company such as Claims, Provider Relations, Customer Care, and Utilization Management to ensure customer requests and questions are handled appropriately and in a timely manner.
• Verify member records for other insurance coverage through phone calls, questionnaires, provider inquiries, and claims to optimize savings to the health plan.
• Maintains daily goals of workflow completion and timeliness standards to provide accurate system data essential to operational functions for all Commercial and Medicare Advantage membership populations.

Education and Experience

• A high school diploma or GED.
• Previous experience in healthcare or medical insurance environment preferred.

Knowledge, Skills, and Abilities

• Knowledge of Microsoft software programs including Word, Excel, and PowerPoint.
• Proven ability to work independently or as a member of a team.
• Excellent communicator (both orally and in writing), with the ability to explain the program offered in an informational, influential, concise, and personable manner.
• Articulate a warm and professional etiquette when speaking on the phone with the members.
• Possess a high-quality of data entry skills and efficiency in Microsoft Office, Word, and Excel.
• Possess an aptitude for multitasking, attention to detail, and ability to handle stressful situations.
• Ability to use critical thinking and decisive reasoning to determine the best course of action in their research.

Travel

No travel required.

Supervisor Responsibility

Not responsible for supervising employees.

Other Duties

Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.

Performs other duties as assigned.