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 a Health Insurance Representative that meets the following requirements:

Education: High school diploma or GED or greater.

Experience: One (1)  years of claims or customer service experience and 1 year of coordination of benefits experience; or any combination of education and experience, which would provide an equivalent background.  The ideal candidate will also have some experience working with customer relation management and/or healthcare records management software

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: Intermediate to advanced knowledge in Microsoft Office Applications.

Language: Bilingual English and Spanish.

The (Other) Health Insurance Representative (OHI) investigates and researches other health coverage for members of Leon Health and uses findings to maintain and accurately update Plan Other Health Insurance (OHI) records housed internally to ensure correct claims coordination and aid in recovery efforts. You will use internal and government systems to identify OHI records and conduct outreach efforts to members, insurers, and employers to develop validate OHI information. You will update member records housed internally and in government systems.

 Primary duties may include, but are not limited to:

 Researching member coverage using online resource and by conducting outreach, both verbally and in writing, to members, insurers, and employers.

  • Keeps a detailed record of all research efforts and outreach attempts within internal systems.
  • Maintains knowledge of state or carrier specific processing rules.
  • Analyze CMS reporting daily and collaborate with internal departments to identify and verify OHI leads.
  • Work escalated and critical inventory within required turnaround times.
  • Report changes to the CMS BCRC online portal.
  • Update and maintain member Medicare Secondary Payer (MSP)/Coordination of Benefits (COB) records housed within internal systems.
  • Assist with special projects, including but not limited to Federal and State audits and state, provider and member complaints.
  • Ability to work from spreadsheets and other inventory assignment processes that are outside of daily queue work.