Medicare Advantage Enrollment Representative

As a member of the Medicare Advantage Operations team, the Medicare Advantage Enrollment Representative plays a crucial role in the enrollment process by reviewing and submitting enrollment requests. This position requires meticulous attention to detail to ensure the accuracy and timeliness of acknowledgment notices sent to members. 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.

This role is responsible for all aspects of enrollment:

• Reviews and submits Enrollment requests received as well as maintaining accuracy and timeliness of acknowledgment notices to members
• Maintains open lines of communication with various departments to resolve member issues and implement ADHOC resolutions to sustain quality member care
• Uses Key Performance Indicator’s (KPIs) to identify trends and risks; manage service and Operating Level Agreement metrics/reporting and present findings
• Reviews Medicaid Aid codes and their corresponding Medicaid level and interpretation for department processes.
• Ensures quality and compliance to meet applicable guidelines; ensure timely, accurate and complete submissions to CMS – Medicare
• Identifies continuous improvement initiatives to streamline processes, reduce member complaints and improve the overall member experience
• Ensures that prospective enrollees are appropriately screened to meet eligibility requirements within regulatory timelines
• Works closely with the Sales and Compliance teams to ensure timely submissions and resolution of eligibility issues, as well as departmental goals and quality goals are met
• Ensures the required member mailings are sent in a timely fashion
• Other duties as assigned

Salary Range: $22.85 – $32.03/Hourly