JeffTemp - Enrollment Intake Specialist

Enrollment Representative

Working under general supervision the Enrollment Representative is responsible for updating eligibility systems with enrollment and membership-related data and performing transactions that result in member enrollment communications as well as notices to State and Federal regulatory agencies. In addition, the incumbent must process transactions to comply with highly regulated eligibility and enrollment procedures. The position is also responsible for explaining eligibility rules and policies of programs to all applicants.

Essential Functions:

• Able to work in a state of constant alertness and a safe manner
• Research and correct eligibility discrepancies identified through error reports
• Update member demographic and eligibility information on the membership eligibility system in response to requests from other business areas
• Reconcile member eligibility data to ensure internal systems match State and Federal information
• Validate eligibility requirements associated with new enrollments, disenrollments, demographic changes, and benefit package changes
• Communicate enrollment discrepancies to State and Federal agencies or their designates
• Resolves outbound and inbound calls to applicants and members
• Review and analyze incomplete applications to identify additional information required to complete the enrollment process
• Coordinate and process Primary Care Physician selections for new members

Supervisory Responsibility:

• NA

Work Environment:

• This job operates in a professional office environment. This role routinely uses standard office and computer equipment.

Physical Demands:

• While performing the duties of this job, the employee is regularly required to talk and hear. This position may occasionally require standing, walking, bending, kneeling, stooping or crouching. The employee must frequently lift and or move items over 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
• Employee may be required to sit for prolonged periods of time.

Travel:

• Minimum to no travel is required for this position.

Work from Home:

• This position may afford the ability to work from home when proficiency levels have been achieved and additional work from home slots are approved.

Education:

• High School Diploma or equivalency required.
• 1-2 years of experience in managed care or healthcare insurance is recommended.

Skills/Abilities (preferred):

• Ability to maintain strict confidentiality of applicant information in the performance of job functions.
• Demonstrated ability to organize work efficiently, evaluate and establish priorities, to handle multiple projects simultaneously.
• Demonstrated ability to receive direction, exercise judgment, and make appropriate decisions in handling confidential and time-sensitive documents and information.
• Able to present oneself professionally when dealing with public contacts and internal staff.
• Able to express oneself clearly and concisely, both verbally and in writing.
• Proven experience with Microsoft Office products

Experience in Medicaid, Medicare, and CHIP eligibility process is highly beneficial.

Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign the Code of Conduct and the Personal Standard Code of Conduct, and are expected to perform their duties ethically and honestly.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America