Sr Rep, Enrollment - Remote - (Must reside in Wisconsin)

$27,893 - $60,445/Yr

Molina Healthcare - Wauwatosa, WI

Full-time

Remote - Wauwatosa, WI

Insurance Carriers and Related Activities

About the position

The Sr Rep, Enrollment is responsible for managing all processes related to membership eligibility inquiries and ensuring the accuracy of membership data within the system. This role serves as a subject matter expert in Enrollment Operations, collaborating with both external clients and internal partners to resolve membership issues. The position requires a deep understanding of eligibility processes and the ability to utilize multiple applications effectively.

Responsibilities

• Handle all processes related to membership eligibility inquiries.
• Ensure membership accuracy within the system.
• Verify other health insurance to establish primary and secondary payors.
• Reconcile eligibility information with State or Federal Agencies.
• Analyze and assist with complex eligibility issues and provide resolutions.
• Respond to, document, track, and quality assure all proceedings with State and/or Federal Agencies.
• Utilize critical thinking skills to communicate eligibility issue trends with Management.
• Manage high volumes of tasks to support regulatory requirements and service level agreements.
• Contribute to technical system enhancements by performing user testing.
• Assist peers and Management to support department goals.
• Train new staff and vendors on assignments.
• Serve as the Subject Matter Expert (SME) for eligibility inquiries.
• Prioritize daily, weekly, and monthly job tasks to meet regulatory requirements.
• Support special projects including regulatory audits.
• Conduct member outreach for clarification or verification of enrollment applications.
• Resolve eligibility exceptions within required State/Regulatory timeframes.
• Perform enrollment functions including call tracking and claims workflow.
• Complete assigned tasks timely and accurately while balancing workload.

Requirements

• Associate degree or equivalent combination of education and experience.
• 1-3 years related work experience.
• Intermediate Microsoft Excel and Microsoft Word skills.

Nice-to-haves

• Bachelor's Degree or equivalent combination of education and experience.
• 3-5 years related work experience.
• Basic knowledge of ANSI X12 834.

Benefits

• Competitive benefits and compensation package.