Enrollment Representative III

Leon Medical Centers•Doral, FL

About The Position

The Enrollment Representative assists callers with complex health-related inquiries, status updates, and potential plan options. The role handles enrollment and billing activities, maintains assigned accounts, and navigates multiple databases to provide accurate, efficient service. The representative communicates with callers in a confident, compassionate manner and works across company functions to ensure requests and questions are handled appropriately and in a timely manner. The position provides customer service to plan members by phone, processes enrollment applications and plan changes, verifies enrollment status, updates records, reconciles beneficiary information across plan and government systems, processes returned mail, fulfills member materials, screens paperwork received from Sales, and documents inquiry outcomes. The representative must be able to work one of the available eight-hour shifts during business hours of 8:00 a.m. to 8:00 p.m. EST.

Requirements

At least one year of sales, account management, or customer service experience.
Bilingual fluency in English and Spanish.
Ability to work any available eight-hour shift during normal business hours of 8:00 a.m. to 8:00 p.m. EST.
Ability to build rapport and respond compassionately by identifying and exceeding customer expectations, responding respectfully and promptly, and consistently meeting commitments.
Ability to listen skillfully, collect relevant information, determine immediate requests, and identify members’ current and future needs.
Problem-solving ability to assess the current state and formulate recommendations.
Ability to translate healthcare-related jargon and complex processes into simple, step-by-step instructions.
Flexibility to adapt communication approaches to different member communication styles and personalities.

Nice To Haves

Familiarity with medical terminology, health plan documents, or benefit plan design.
Experience working with vulnerable populations.
Sales, account management, or customer service experience in a Health Management Organization is preferred.

Responsibilities

Provide telephonic customer service to plan members.
Respond to incoming calls and initiate outgoing calls to answer enrollment questions, resolve issues, and educate callers.
Verify enrollment status and update patient records.
Address enrollment questions and concerns.
Process enrollment applications and plan change requests.
Reconcile beneficiary information in the plan membership system with government systems and reports, including Marx, FLMMIS, MMR, DTRR, LEP, and Detail.
Process returned mail, including scanning, and assist in researching invalid address information.
Fulfill member materials, including beneficiary forms.
Screen forms and data for paperwork received from Sales.
Document inquiry outcomes thoroughly for accurate tracking and analysis.
Develop and maintain positive customer relations and coordinate across company functions to handle customer requests and questions appropriately and promptly.