Membership Representative II

Alignment Healthcare•Orange, CA

9d•$41,600 - $57,600

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Membership Representative II performs daily operations regarding member disenrollments, retro processing, reinstatements and Out of Area (OOA). Ensures members are properly process within Centers of Medicare and Medicaid (CMS), the third party vendors and EZ-Member.

Requirements

High school diploma or general education degree (GED); or one to three years related experience and/or training; or equivalent combination of education and experience.
Knowledge of Medicare Managed Care Plans.
Two to three years customer service experience.
Direct sales or related experience preferably in the Managed Care industry.
Bi-lingual (English/Spanish) required.
Must be familiar with CMS MMR and TRR files
Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of the organization.
Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.
Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
Ability to deal with problems involving a few concrete variables in standardized situations.
Strong computer skills.
Strong organizational skills.
Good telecommunications skills.
Good organizational skills.

Responsibilities

Processes all disenrollments from the Weekly TRR and Monthly.
Ensures we have the correct documentation in EZ-Member.
Ensure all correspondence is mailed to members on a timely manner.
Reviews on a weekly basis the Weekly TRR.
Follows up with any pending enrollments or rejections.
Submits in a timely manner to the 3rd party vendor any retro disenrollments, cancellation, retro enrollments, reinstatements and OOA’s. Ensures they are processed correctly.
Monitors all submission to 3rd party vendor ensures all submissions are processes within the correct time frame.
Submits monthly reports to the Membership Director of Monthly submissions to 3rd party vendor including OOA, Retro Enrollments, Retro Disenrollments and Reinstatements
Ensures all members outside of the service area are processed on a timely manner and ensure the letters are mailed with in CMS guidelines in order to be compliant.
Act as liaison representative to the Sales Representatives.
Provide any issues identified to the necessary internal department heads.
Assist in the departmental compliance tasks which include the Mailing, Annual Notification of Coverage Letter and any other necessary compliance mailing.
Performs other duties as assigned.