Representative, Enrollment-Madison,WI

Molina Healthcare•Long Beach, CA

About The Position

Provides support for member enrollment activities including preparation, processing and maintenance of new members and reenrollment. Processes and maintains health plan member and enrollment records, employer monthly reports and sends membership cards and materials accordingly. Provides customer service to plan members, providers, and employer groups by answering benefit questions, verifying enrollment status, researching and resolving enrollment system rejections and issues and providing support to callers.

Requirements

Up to 1 year of experience in health care, and/or customer/provider services experience, or equivalent combination of relevant education and experience.
Customer service experience.
Data processing and proofing experience.
Attention to detail, organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Responsibilities

Resolves the following member eligibility exceptions within the required state/regulatory timeframes: member enrollment file errors, identification (ID) card generation errors, primary care physician (PCP) assignments and 834 enrollment files to vendor/third party administrators.
Processes member coverage of eligibility (COB) to ensure accurate information is represented in Molina’s enrollment system.
Assists with the support of newborn enrollment functions to include: call center requests for verification and updates, PCP assignment activity, enrollment record error reports, enrollment/disenrollment activity and mass member moves.
Manages claims queue to ensure timely and accurate processing of claims pended due to enrollment or COB related issues.
Serves as subject matter expert (SME) for application data entries for the enrollment process.
Processes mail returned by members - providing updates or requested information.
Processes mail returned for insufficient or inaccurate addresses; remails as indicated, and reports inventory as required by department policy.
Maintains the intake process for department e-mails and distributes as appropriate.
Facilitates the IServe process and makes assignments to the vendor and/or senior level support as appropriate.
Completes the Centers for Medicare and Medicaid Centers (CMS) Online Enrollment Center (OEC) process - pulling applications from the online portal and managing the intake process accordingly.