Enrollment Representative [United States]

 

Job Details

Job Location

Any Location/Remote (US) - , OK

Remote Type

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Fully Remote

Position Type

Full Time

Education Level

High School or Equivalent

Travel Percentage

None

Job Shift

Day

Job Category

Admin - Clerical

WHO WE ARE:

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

WHO YOU ARE

The Enrollment Representative will create and maintain membership records and assists internal departments with eligibility inquiries and pharmacy eligibility.

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.
• Meets 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:

High school diploma or GED

EXPERIENCE:

Knowledge or 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.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

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