Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via call tracking, claims, or e-mail. Maintain records in the enrollment database. KNOWLEDGE/ SKILLS/ ABILIT... more details
JOB DESCRIPTION
Job Summary
Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via call tracking, claims, or e-mail. Maintain records in the enrollment database.
KNOWLEDGE/SKILLS/ABILITIES
Performs processes to resolve the following eligibility exceptions within the required State/Regulatory timeframes: enrollment file errors, ID card generation errors, PCP assignments and 834 enrollment files to vendor/third party administrators.
Process COB eligibility through Molina application to ensure accurate information is represented in Molina's enrollment system.
Assists with the support of the newborn enrollment functions, to include call center requests for verification and updates, PCP assignment activity, enrollment record error reports, enrollment/disenrollment activity and Mass Member Moves.
Work on claims queue to ensure timely and accurate processing of claims pended due to enrollment or COB related issues.
Serves as the Subject Matter Expert (SME) for application data entry to the enrollment process
Processes the mail returned by the member providing updates or requested information
Processes the mail returned by the USPS for insufficient or inaccurate address; remailing as indicated and reporting inventory as required by department policy
Maintains the intake process for department e-mail and distributes as appropriate
Works the I Serve process and makes assignments to the vendor and/or Sr. Enrollment Rep as appropriate
Works the CMS OEC process, pulling applications from the on-line portal and pushing them through the intake process
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experience
Required Experience
1-3 years
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
3-5 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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