Operational Support - Enrollment Review Specialist

Community Care • Tulsa, OK

3d

About The Position

The Operational Support - 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 through quality monitoring audits and accuracy data, analyzes monthly trends to identify improvements and mitigate risk, and provides process-improvement feedback to the trainer. The specialist also prepares and maintains quality performance profiles for enrollment representatives and is responsible for policies related to eligibility review. Other job-related duties may be assigned.

Requirements

• High school diploma or equivalent.
• Two years of experience in an auditor capacity.
• 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.
• Understanding of eligibility terms and application.
• Prior working knowledge of eligibility/member-related work in the managed care insurance industry.

Nice To Haves

• College degree.
• Experience in the managed healthcare or insurance industry.
• HMO experience.

Responsibilities

• Review eligibility changes and recommend ways to improve individual representatives’ effectiveness.
• Review Medicare Advantage TRR changes.
• Maintain quality-monitoring audits, accuracy percentages, and other required data elements to support performance guarantees.
• Identify and analyze monthly data trends to identify improvements and mitigate risk.
• Provide feedback to the trainer for continual process improvement.
• Prepare and maintain quality performance profiles for each enrollment representative.
• Handle 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