Job Abstract

As a member of the Medicare Advantage Operations team, the Senior Medicare Advantage Enrollment Representative plays a pivotal role in processing all enrollment, disenrollment, and cancellation requests. This position requires a deep understanding of Medicare Part D programs and meticulous attention to detail to ensure accurate and timely processing. The ideal candidate will possess excellent communication skills and the ability to collaborate with various departments to address member issues promptly and implement ADHOC resolutions to sustain quality member care.

Responsibilities include:

• Ensure accurate completion of enrollments in accordance with CMS and other Managed Care Guidelines
• Process all Enrollment, Disenrollment, cancellation requests, reinstatements and managed retro reconciliation files or requests
• Reconcile daily Transaction Reply Report (TRR) and retro reconciliation files
• Maintain oversight on the accuracy and timeliness of acknowledgment notices sent to members
• Maintain open lines of communication with various departments to resolve member issues promptly and implement ADHOC resolutions to sustain quality member care
• Understand all aspects of enrollment operations, Medicare membership enrollment, reconciliation, and benefits coordination operations
• Hands-on experience with 834 EDI, State (CA DHS), and CMS files

We’re seeking detail-oriented, self-directed professional with:

• High School Diploma or equivalent work experience required
• Required a minimum of three years’ experience in a Medicare health plan or Managed Care – Enrollment, Disenrollment and Reconciliation
• Robust knowledge of Medicare and CMS enrollment and billing regulatory requirements
• Initiative, problem identification, resolution and analytical skills are essential
• Excellent oral and written communication skills are required
• Ability to modify and adapt operational procedures to changing operational needs
• Ability to develop, implement, and evaluate methods and systems to improve efficiency
• Proven skills to lead and facilitate cross-functional workgroups and other meetings
• Ability to work as part of a team, collaborating with colleagues
• Ability to analyze and organize complex federal and private insurance regulations
• Ability to travel/attend off-site meetings and conferences