Enrollment Specialist

Our client, a Healthcare company, is looking for an Enrollment Specialist for their Marshfield, WI location.

• Ensure positive customer interactions with one major product line
• Interact with members, applicants, providers, and agents via telephone.
• Identify the customer's concern and appropriately research and resolve the inquiry in a timely manner.
• Provides accurate and timely answers to benefit, coverage, premium and claims questions in person, via telephone to ensure member satisfaction.
• Assists with coordinating out-of-area or non-affiliated provider referrals for members requiring care outside of the Security Health Plan service area to ensure members receive needed medical care in a timely fashion.
• Answers Center for Medicare and Medicaid Services (CMS) test calls in an accurate and timely manner to ensure compliance with CMS guidelines.
• Assists Federally Facilitated Marketplace (FFM) members in updating financial and subsidy information to ensure compliance with the federal government and the Affordable Care Act (ACA).
• Documents interactions with members electronically to ensure member records are accurate and available for future use of other staff.
• Utilizes electronic systems to verify and assist members with questions or concerns regarding wellness benefits to ensure members are reimbursed correctly for wellness activities.
• Troubleshoots online portal and secure email issues for members to ensure they are able to access and view information electronically.
• Assists members in filing complaints or grievances using internal and/or federal guidelines to ensure complaints are handled and resolved correctly.
• Participates in continual coaching to maintain call volume, processing metrics and accuracy goals to ensure compliance with accreditation guidelines.
• Regular attendance is required in order to carry out the essential functions of the position.
• Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge and abilities to perform, within scope, role specific functions.
• May be asked to assist with current Medicare Advantage members with plan changes using documented scripts provided by the Centers for Medicare and Medicaid Services (CMS) to ensure members are enrolled in the correct plan.
• Other duties as assigned.

• High School Diploma or equivalent
• Two years' experience with customer service.
• Demonstrated proficiency with handling high-pressure situations and with verbal and written communication.
• Experience working in a health insurance call center.

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

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