Job Description

Would you like to join a dynamic team dedicated to improving the lives of the people we come in contact with?  Are you sensitive to the needs of the elderly?  

We are seeking Enrollment Specialists that meet the following requirements:

Essential Functions:

  • Responds to incoming calls and may initiate outgoing calls, providing customer service to plan members and providers by answering benefit questions, resolving issues and educating callers.
  • Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections; addresses a variety of enrollment questions and/or concerns received by phone or mail.
  • Receives, distributes and tracks all incoming enrollment applications and plan change requests.
  • Conducts quality review of enrollment applications and plan change requests received from beneficiaries, the Sales Department, and the Centers for Medicare and Medicaid Services (CMS) and conducts necessary outreach and research to address all identified discrepancies.
  • Performs end-of-day reconciliation of processed enrollments, plan change requests, disenrollments and cancellations.
  • Processes voluntary disenrollment and cancellation requests.
  • Generates member communications within required timeframes and conducts intermittent quality reviews
  • Processes return mail (including scanning) and assists with researching invalid address information.
  • Bills, collects premiums and reconciles payments.
  • Notifies clients of premium discrepancies through payment adjustment notices.
  • Screens all forms and data for all paperwork received from Sales.
  • Thoroughly documents inquiry outcomes for accurate tracking and analysis.
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
  • Complies with State and Federal regulations and guidelines and enterprise policies and procedures pertaining to member privacy and confidentiality of protected health information (PHI) and personally identifiable information (PII).
  • Assists with a variety of special projects as defined by the Membership Department Manager.
  • Performs basic job functions with help from co-workers, specialists and managers on non-basic issues.

Education: High school diploma or GED or greater.

Experience: One (1) year of experience as a Membership/Enrollment Representative for a Medicare HMO.

Basic understanding and ability to apply Centers for Medicare and Medicaid (CMS) regulatory requirements and standard operating procedures. 

Exception problem solving skills.

Must be able to effectively communicate verbally.

Computer Skills: Proficient in Microsoft Office Applications.

Language: Bilingual English and Spanish.