Enrollment Representative (Temporary)

Job Number: 6457

Workplace Type: Office Full-Time

Position Title: Enrollment Representative

External Description:

Overview of the role:

The Enrollment Representative is responsible for all new plan enrollments. Researching validating and reconciling enrollments from the error reports and CMS (Center for Medicare and Medicaid Services) daily files. Ensures all data entry is completed with the require time frame.

Responsibilities:

• Sending correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections. Ensure the TRR is reviewed daily.
• Submit daily transaction files to CMS.
• Ensure that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare
• Advantage Enrollment and Disenrollment manual).
• All OEV letters are to be logged in the membership data base.
• Act as a liaison to the Sales Representatives. Ensure that new enrollments are processed properly. Provide any issues identified to the necessary internal department heads.
• Data entry of all enrollment applications as well as disenrollments into plan’s data system.
• Track all pending enrollments for additional information needed for qualification.
• Assist in the departmental compliance tasks which include the Working Aged Survey Mailing, Annual Notice of Change Letter, Health Care Risk Assessment mailings, and all other necessary compliance mailings.
• Submit monthly reports to the Membership Manager, enrollment applications processed and returned, member appointments scheduled, and number of mailed packets and returned mail.

Supervisory Responsibilities
This job has no supervisory responsibilities.

Required Skills & Experience:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
• Knowledge of Medicare Managed Care Plans.
• Two to three years customer service experience.
• Direct sales or related experience preferably in the Managed Care industry.
• Bi-lingual (English/Spanish) required.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
• Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
• Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s.
• Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
• Ability to deal with problems involving a few concrete variables in standardized situations.
• Strong computer skills.
• Strong organizational skills.
• Good telecommunications skills.
• Attention to detail a must.

Pay rate: $36,200.00 - $54,300.00 annually

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Enrollment Representative (Temporary)

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].