Our Enrollment Representatives facilitate the processing, coordination, and handling of all Medicare enrollment and disenrollment functions in a timely and accurate manner with internal departments and CMS; provide general assistance to Member Services Department

This position is onsite at our Anaheim office. M-F 7am-4pm, some OT required.

ROLE RESPONSIBILITIES

• Handle and process all member enrollment, disenrollment, and cancellation requests; Duties include but not limited to:
  • PDF all incoming applications and disenrollments from email Inbox fax or electronic enrollment via enrollment site, or OEC (mailed in (scan), emailed in)
  • Verify and print beneficiary eligibility evidence for Part A/B, Medi-cal and Wipro (infocrossing)
  • Date stamp, sort and combine application with eligibility into PDF packets. (Manage each application with its down individual folders for back up)
• Screen all incoming application and follow up with broker for all discrepancies / missing information to ensure application is complete.
• Key application into Enrollment system for tracking and confirmation purposes
• Process enrollment applications: Data entry of prospective member into enrollment system for completed enrollments that have been evaluated with an assigned election type/code.
• Generate submission report and upload enrollment application to member profile on a daily basis
• Print auto-generated notices (OEV, DIS, REJ, CAN, RFI etc.). Upload, call log and mail out.
• Verification of member with Medi-Cal eligibility through online verification for DSNP/CSNP monthly process
• Notify Broker Relations Department when questionable or non-compliant pattern is identified with specific brokers.
• Outbound calls to members for research or obtaining additional information
• Participating in Team chats, emails and meetings related to Department operations
• Conduct any necessary research on questionable applications by working with supervisory staff.
• Coordinate with Marketing Department to properly track the mailing of ID cards, and all other applicable letter/notices to members after enrollment completion
• May receive transferred calls from Member Services Department and/or other departments. Inform Supervisor / Manager of issues encountered and provide resolution in a timely manner
• Assist in translation and proofreading upon request from upper management and the marketing department.
• Follow defined work schedule. Be ready to handle outbound customer calls and assignments in a professional manner; must follow company and department guidelines for all time off/vacation/overtime requests, especially during enrollment season; Work on assigned/required weekends and after hours during open enrollment season.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School diploma or GED required.
• One (1) to three (3) years of health plan or clerical experience required.
• Previous knowledge and/or experience working with Managed Care, and/or Medicare Advantage required.
• Bilingual in Spanish preferred
• Previous experience in customer service

PROFESSIONAL COMPETENCIES

• Strong communication skills, both verbal and written (bilingual is a plus, but not required)
• Must be detailed oriented and present critical analytical thinking skills
• Must display active listening skills
• Must present strong ability to read and comprehend material presented both orally and in writing
• Organized and be able to prioritize work to meet deadlines
• Works independently with little supervision
• Able to thrive and adapt in a fast paced, stressful environment
• Must be flexible to change and open to learning new tasks as assigned
• Must have experience using Microsoft Office, along with general typing skills
• Understanding of regulatory and compliance rules surrounding enrollment and eligibility

WORK ENVIRONMENT

In normal circumstances, the majority of work responsibilities are performed in a home office or open office setting, carrying out detailed work as assigned, sitting in a workspace, and working with a computer or other office equipment. Must be required to be able to sit for approximately 70% daily. Some travel may be required.

For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $17.13-$23 Hourly.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid holidays, plus 2 floating holidays per year; and a lifestyle spending account.