The Customer Solution Center Enrollment Services Representative II is responsible to audit, research, update and maintain the member data integrity in the core system such as provider and plan partner assignments, member demographics, troubleshoot complex issues, etc. for all lines of business. This position audits inbound eligibility file load errors, intake forms and e-mail requests; makes recommendation or updates member information and other related transactions as needed within the timefram... more details
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Customer Solution Center Enrollment Services Representative II is responsible to audit, research, update and maintain the member data integrity in the core system such as provider and plan partner assignments, member demographics, troubleshoot complex issues, etc. for all lines of business. This position audits inbound eligibility file load errors, intake forms and e-mail requests; makes recommendation or updates member information and other related transactions as needed within the timeframe as outlined in the company policies and procedures. Collaborates with internal/external departments to ensure timely resolution to member issues and member access to care. Assists with user acceptance testing (UAT) related to system and/or process defects and issues. Provides support and ownership of any escalated and/or complex issues related to member coverage preventing from member access to care.
Duties
Daily audit inbound eligibility load errors, intake form and e-mail requests related to member coverage, provider and plan partner assignments, manual update to member demographic and other related transactions preventing member access to care. Support internal/external departments and make recommendation as needed. (20%)
Timely processing of work assignments and maintain accuracy of provider and plan assignments as outlined in the company policies and procedures. (60%)
Assist the department in user acceptance testing (UAT) to improve/enhance processes. (5%)
Assist the department in the development of desktop level procedure (DLP). (5%)
Perform other duties as assigned. (10%)
Duties Continued
Education Required
High School Diploma/or High School Equivalency Certificate
Education Preferred
Experience
Required: Minimum of 1 year of member eligibility data experience in a healthcare environment.
Experience with and knowledge of Medi-Cal, Medicare, Market Place/Exchange, Commercial and Individual product lines and other related government-funded/sponsored healthcare programs.
Preferred: Previous experience in Managed Health, preferably in Customer Service, Enrollment Services/or Claims.
Skills
Required: Strong research, auditing, multi-tasking, problem-solving and verbal/written communication skills
Intermediate computer skills including MSOffice Suites as well as member processing system such as QNXT or MHC.
Preferred: Knowledge in MARx and AEVS
Knowledge in 834, TRR, HCO or RTZ member eligibility electronic files.
Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
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