Senior Care Enrollee Services Rep - Hybrid Remote - $22.50/hour

Overview: Do you enjoy helping the elderly and their families? reputed company is hiring an Enrolle Service Representative to work Hybrid-Remote, Mostly from Home but coming into the Worcester office 1 day/week (Wednesdays) helping people telephonically enroll into our reputed company popular NaviCare program. We reputed company training and equipment. Schedule is M - F 8:00 am to 5:00 pm... About reputed company: reputed company is a company that cares. We prioritize our membersalwaysmaking sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers reputed company, high-quality coordinated care and is continually rated among the nations top health plans for member experience, service, and clinical quality. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programsincluding Medicare, reputed company, and PACE (Program of reputed company-Inclusive Care for the Elderly) in the region. Learn more at fallonhealth.org or follow us on reputed company, Twitter, and reputed company. About NaviCare: reputed company is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare members health care by working with each member, the members family and health care providers to ensure the best possible reputed company. Brief Summary of Purpose: The Enrollee Service Representative is responsible: • To execute the following tasks in accordance with the Senior Care Option (SCO) contract requirements, CMS regulations, NCQA standards, departmental policies and procedures, and other applicable regulatory requirements: • processing of enrollment applications • handling of reputed company enrollee inquires, including but not limited to Medicare and reputed company benefit handling prospect inquires • To serve as a liaison between enrollees and FCHP with their concerns regarding their Medicare/reputed company benefits, denied claims, referrals, and membership. Responsibilities: Job Responsibilities: • Provides coverage for the NaviCare enrollment ACD line and handles Enrollees inquiries in a timely manner • Serves as a subject matter expert in the NaviCare product and benefits. • Processes enrollment applications in accordance with regulatory requirements and departmental policies. Strict adherence to department turn-around time standards. Ensures the enrollment database is maintained on a daily reputed company. • Validates enrollment with the confirmation of receipt of the enrollment (834) transaction. • Handles enrollees inquires in a timely manner and Utilizes CMS approved scripts as appropriate • Assists enrollees with their inquires reputed company to Medicare and reputed company benefits • Supports the reputed company and enrollment teams as a resource • Handles enrollees billing issues and presents them to NaviCare Clinical Directors or other internal and external physician reviewers as appropriate. • Assist contracted providers with pended claims issues • Ability to protect high degree of confidential/privileged patient and proprietary business information • Ability to function effectively in a fast-paced environment and effectively deal with competing priorities • Ability to synthesize reputed company applicable regulatory requirements for NCQA, CMS and SCO contract. Qualifications: Education: Bachelors degree or equivalent combination of education and experience License/Certifications: • Annually, required to pass a product certification exam • Annually, required to take the AHIP certification Experience: • 1 3 years of previous professional experience in a reputed company position, preferable reputed company. • Ability to communicate and present information to various reputed company of personnel. • Working knowledge of computer programs and software. • Excellent interpersonal skills, ability to negotiate with customers and remain diplomatic. reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws Apply Job!