Enrollment Representative

Under direct supervision, is responsible for a variety of specific functions associated with enrollment and reconciliation transactions to facilitate accurate enrollment data. He/she processes enrollment data within a timeframe and at a performance level that ensures members timely access to benefits and accurate processing of claims. He/she will compile the eligibility discrepancies in a timely manner to ensure that members are able to obtain health services appropriately.

He/she also works collaboratively with various internal departments to resolve complex issues related to member eligibility and provider discrepancies to meet the Mission, Vision and Values of Neighborhood.

Duties and Responsibilities Responsibilities may include, but are not limited to, the following:

Maintain membership eligibility information in system

Generate membership correspondence

Produce enrollment activity reports for internal and external customers

Interact with internal and external contacts regarding membership and eligibility issues

Reporting and billing of births

Manual data entry of newborns, exception reports and daily spreadsheets

Provide enrollment information to internal customers about enrollment issues

Act as secondary contact in communicating with EOHHS, HP, DCYF and/or HSRI to resolve enrollment issues

Communicate to the Member Services department the status of enrollment processes

Support and work collaboratively with the next level analysts in handling some tasks related to Coordination of Benefits, including research, outreach and reporting

Provide back up to the next level analysts in a limited scope

Maintaining absolute file integrity with regards to content, location and confidentiality

Participate in training and development

Identify opportunities for process improvements and workflow efficiencies

Other duties as assigned

Qualifications

Required:

High School Degree or equivalent

Three (3) years’ HMO/insurance experience in member service/enrollment

Communication skills, including excellent writing abilities

Intermediate skills in Microsoft Office (Word, Excel, Outlook)
Organizational skills and reporting experience

Ability to work independently and as a team player

Strong attention to detail and problem solving skills

Ability to handle multiple responsibilities simultaneously

Ability to work cross-functionally across different departments within the organization

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
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