Senior Representative, Enrollment (Remote)

Job description

JOB DESCRIPTION Job Summary Provides senior level support for member enrollment activities. Collaborates with internal and external partners - leveraging expertise and knowledge of enrollment function to resolve member enrollment/eligibility issues. Essential Job Duties: - Resolves eligibility issues including but not limited to: incoming/outgoing eligibility, primary care provider (PCP) assignment and member identification (ID) card processing. - Verifies other member health insurance to establish primary and secondary payors in the system. - Reconciles eligibility information with state or federal agencies using varied methods. - Analyzes and assists with complex member eligibility issues, and provides resolution to internal partners, external client and regulators (Centers for Medicare and Medicaid Services (CMS), federal/state exchanges, etc.). - Responds, documents, tracks and ensures quality for all proceedings with state and/or federal agencies (including member complaints) within required service level agreements (SLAs). - Utilizes critical-thinking skills to proactively communicate eligibility issue trends to leadership. - Manages high-volumes of tasks to support regulator...