Enrollment Resolution Examiner I

About the role

The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas.

Responsibilities

• Reconcile regulatory and Health Plan Enrollment data through audit and review, utilizing internal and external guidelines/regulations/policies and procedures.
• Ensure member and/or group documentation and transactional updates are completed to reconcile account discrepancies.
• Receive, review and update discrepancies from internal departments and external customers relating to Membership subscriber/member/group files.
• Invest