Hybrid Enrollment Representative (Orange, CA)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them.

About the role

The hybrid Enrollment Representative is responsible for all new plan enrollments, researching, validating, and reconciling enrollments from error reports and CMS (Center for Medicare and Medicaid Services) daily files. Ensures all data entry is completed within the required time frame.

Responsibilities

• Sends correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections.
• Ensures the TRR is reviewed on a daily basis.
• Submits daily transaction files to CMS.
• Ensures that all enrollments, denials, and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).
• Acts as a liaison to the Sales Representatives.
• Ensures that new enrollments are processed properly.
• Provides any issues identified to the necessary internal department heads.
• Conducts data entry of all enrollment applications as well as disenrollments into the plan’s data system.
• Tracks all pending enrollments for additional information needed for qualification.
• Assists in departmental compliance tasks which include the Working Aged Survey Mailing, Annual Notice of Change Letter, Health Care Risk Assessment mailings, and all other necessary compliance mailings.
• Submits monthly reports to the Membership Manager, including enrollment applications processed and returned, member appointments scheduled, and number of mailed packets and returned mail.

Requirements

• Minimum 2 years of customer service experience.
• High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.
• Ability to communicate positively, professionally, and effectively with others; provide leadership, teach, and collaborate with others.
• Knowledge of Medicare Managed Care Plans.
• Effective written and oral communication skills; ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors.
• 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. Ability to speak effectively before groups of customers or employees.
• 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. Ability to deal with problems involving a few concrete variables in standardized situations.
• Problem-Solving Skills: Effective problem-solving, organizational, and time management skills and ability to work in a fast-paced environment.

Preferred Qualifications

• Direct sales or related experience, preferably in the Managed Care industry.
• MBA.
• Bi-lingual (English/Spanish).

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.

• While performing the duties of this job, the employee is regularly required to talk or hear.
• The employee is regularly required to stand, walk, sit, use hands to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds.
• Specific vision abilities required by this job include close vision and the 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.