Operational Support - Enrollment Review Specialist

CommunityCare • Tulsa, OK

4d

About The Position

The Enrollment Review Specialist monitors and reviews eligibility changes made by Enrollment department staff to ensure quality standards are met. The role reviews Medicare Advantage TRR changes, supports performance guarantees by maintaining quality-monitor audits and accuracy percentages, and analyzes monthly data to identify trends, improvements, and risks. The specialist provides feedback to the trainer for continual process improvement, maintains quality performance profiles for enrollment representatives, and is responsible for policies pertaining to eligibility review. Other job-related duties may be assigned.

Requirements

• Strong oral and written communication skills.
• Excellent interpersonal skills.
• Ability to read, analyze, and interpret complex documents, including health benefit booklets.
• Ability to maintain and preserve highly confidential information.
• Proficiency in Microsoft Office applications.
• Successful completion of a Health Care Sanctions background check.
• Highly organized and attentive to detail.
• High school diploma or equivalent required.
• Two years of experience in an auditor capacity.
• Understanding of eligibility terms and applications.
• Prior working knowledge of eligibility/member-related experience in the managed care insurance industry.

Nice To Haves

• College degree preferred.
• Managed healthcare or insurance industry experience preferred.
• HMO experience preferred.

Responsibilities

• Review eligibility changes and recommend ways to improve individual representatives’ effectiveness.
• Review Medicare Advantage TRR changes.
• Support performance guarantees by maintaining quality-monitor audits, accuracy percentages, and other required data elements.
• Identify and analyze trends in monthly data to identify improvements and mitigate risk.
• Provide feedback to the trainer to support continual process improvement.
• Prepare and maintain quality performance profiles for each enrollment representative.
• Manage policies pertaining to eligibility review.
• Perform other job-related duties as assigned.

What This Job Offers

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