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.

Essential Job Duties

• 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 methods. • Analyzes and assists with reputed company member eligibility issues, and provides resolution to internal partners, external client and regulators (Centers for Medicare and reputed company Services (CMS), federal/state exchanges, etc.). • Responds, documents, tracks and ensures quality 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 projects 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: call 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 timely 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 quality reviews and submission of deliverables to government reputed company team and state reputed company agencies.

Required Qualifications

• 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 projects and tasks to meet internal deadlines. • Ability to maintain confidentiality and reputed company with the Health Insurance Portability and Accountability Act (HIPAA). • Ability to establish and maintain positive 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.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V