Job Description

Job Title: Enrollment Representative

Position Summary: The Enrollment Representative is responsible for accurately processing, reviewing, and updating enrollment applications for Medicare Advantage Plans in compliance with CMS guidelines and company policies. This role requires strong attention to detail, excellent communication skills, and the ability to meet high productivity and accuracy standards in a fast-paced environment.

Responsibilities / Job Duties

• Accurately, enter, review, and update enrollment applications
• Verify applicant eligibility for Medicare Advantage Plans, ensuring compliance with CMS guidelines
• Review applications for completeness, required documents, and accuracy before submission
• Process plan changes, denials, and special election request as applicable
• Maintain up-to-date knowledge of CMS enrollment guidelines, HIPAA requirements, and company policies
• Identify, document, and escalate enrollment discrepancies or errors in accordance with compliance protocols
• Perform qualify check on one’s own work to meet accuracy metrics
• Respond to internal inquiries from agents, brokers, and customer service teams regarding enrollment status
• Provide clear, professional communication to resolve application issues in a timely manner
• Collaborate with internal departments to ensure prompt resolution of enrollment-related issues
• Consistently meet or exceed productivity, accurate, and timeliness goals for enrollment processing (metrics = processing 80-110 applications, about 8-10/hour, they will ramp them to this)
• Track daily work volumes, turnaround times, and error rates in line with department performance standards
• Accurately, enter, review, and update enrollment applications
• Verify applicant eligibility for Medicare Advantage Plans, ensuring compliance with CMS guidelines
• Review applications for completeness, required documents, and accuracy before submission
• Process plan changes, denials, and special election request as applicable
• Maintain up-to-date knowledge of CMS enrollment guidelines, HIPAA requirements, and company policies
• Identify, document, and escalate enrollment discrepancies or errors in accordance with compliance protocols
• Perform qualify check on one’s own work to meet accuracy metrics
• Respond to internal inquiries from agents, brokers, and customer service teams regarding enrollment status
• Provide clear, professional communication to resolve application issues in a timely manner
• Collaborate with internal departments to ensure prompt resolution of enrollment-related issues
• Consistently meet or exceed productivity, accurate, and timeliness goals for enrollment processing (metrics = processing 80-110 applications, about 8-10/hour, they will ramp them to this)
• Track daily work volumes, turnaround times, and error rates in line with department performance standards

Requirements:

• High school diploma, GED, or transcripts
• Minimum 1 year of data entry experience with strong business or office skills
• Administrative experience in a healthcare setting highly preferred.
• Computer proficient

Schedule / Shift

• Mon-Fri (9am-6pm PST), some Saturdays
• Overtime will be required
• On-site

Job Tags

Similar Jobs