Customer Solution Center Enrollment Services Representative II

L.A. Care Health Plan • Los Angeles, CA

6d

About The Position

The Customer Solution Center Enrollment Services Representative II is responsible to audit, research, update and maintain the member data integrity in the core system such as provider and plan partner assignments, member demographics, troubleshoot complex issues, etc. for all lines of business. This position audits inbound eligibility file load errors, intake forms and e-mail requests; makes recommendation or updates member information and other related transactions as needed within the timeframe as outlined in the company policies and procedures. Collaborates with internal/external departments to ensure timely resolution to member issues and member access to care. Assists with user acceptance testing (UAT) related to system and/or process defects and issues. Provides support and ownership of any escalated and/or complex issues related to member coverage preventing from member access to care.

Requirements

• High School Diploma/or High School Equivalency Certificate
• Minimum of 1 year of member eligibility data experience in a healthcare environment.
• Experience with and knowledge of Medi-Cal, Medicare, Market Place/Exchange, Commercial and Individual product lines and other related government-funded/sponsored healthcare programs.
• Strong research, auditing, multi-tasking, problem-solving and verbal/written communication skills
• Intermediate computer skills including MSOffice Suites as well as member processing system such as QNXT or MHC.

Nice To Haves

• Previous experience in Managed Health, preferably in Customer Service, Enrollment Services/or Claims.
• Knowledge in MARx and AEVS
• Knowledge in 834, TRR, HCO or RTZ member eligibility electronic files.
• Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.

Responsibilities

• Daily audit inbound eligibility load errors, intake form and e-mail requests related to member coverage, provider and plan partner assignments, manual update to member demographic and other related transactions preventing member access to care. Support internal/external departments and make recommendation as needed.
• Timely processing of work assignments and maintain accuracy of provider and plan assignments as outlined in the company policies and procedures.
• Assist the department in user acceptance testing (UAT) to improve/enhance processes.
• Assist the department in the development of desktop level procedure (DLP).
• Perform other duties as assigned.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED