The Member Enrollment Representative performs a variety of specific functions associated with enrollment to facilitate accurate enrollment data for all products.
KEY FUNCTIONS/RESPONSIBILITIES:
- Research and resolve daily materials error report issues.
- Accurately process PCP Routing Queue (requests from Customer Care to update PCPs) daily.
- Process Claims Routing Queue to ensure claims can be re-processed with no issues.
- Using the PCP Selection Form, update Member’s PCP and demographics.
- Work PCP Error Report by correcting error in PCP Assignments (gaps in coverage, inappropriate assignments, etc.).
- Responsible for conducting all processes associated with enrolling newborns into the Plan, including Newborn Temporary Record Creation, Eligibility and Faxing).
- Research Casehead information from 834 data and MassHealth Virtual Gateway to update member’s casehead as appropriate.
- Performs other duties as assigned.
QUALIFICATIONS:
EDUCATION:
- Associate degree or equivalent combination of education, training, and work experience is required.
EXPERIENCE:
- 1 or more years experience in an administrative, clerical position within the insurance, financial or health care industry is required.
- Additional post-secondary education may be substituted for work experience.
- 1 year Operations experience in a managed care or healthcare environment is preferred.
COMPETENCIES, SKILLS, AND ATTRIBUTES:
- Excellent customer service skills are required.
- Detail oriented with a commitment to accuracy.
- A strong working knowledge of Microsoft Office products.
- Ability to work with a team as well as independently.
WORKING CONDITIONS AND PHYSICAL EFFORT:
- Regular and reliable attendance is an essential function of the position.
- Ability to work overtime in peak periods.
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required Skills
Required Experience