About The Role

Job Details

Working under general supervision The Enrollment Representative is responsible for updating eligibility systems with enrollment and membership-related data and performing transactions that result in member enrollment communications as well as notices to State and Federal regulatory agencies. In addition, the incumbent must process transactions to comply with highly regulated eligibility and enrollment procedures. The position is also responsible for explaining eligibility rules and policies of programs to all applicants.

Job Description

Essential Functions

Able to work in a state of constant alertness and a safe manner
Research and correct eligibility discrepancies identified through error reports
Update member demographic and eligibility information on the membership eligibility system in response to requests from other business areas
Reconcile member eligibility data to ensure internal systems match State and Federal information
Validate eligibility requirements associated with new enrollments, disenrollments, demographic changes, and benefit package changes
Communicate enrollment discrepancies to State and Federal agencies or their designates
Resolves outbound and inbound calls to applicants and members
Review and analyze incomplete applications to identify additional information required to complete the enrollment process
Coordinate and process Primary Care Physician selections for new members

Supervisory Responsibility

Work Environment

This job operates in a professional office environment. This role routinely uses standard office and computer equipment.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job.

While performing the duties of this job, the employee is regularly required to talk and hear. This position may occasionally require standing, walking, bending, kneeling, stooping or crouching. The employee must frequently lift and or move items over 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Employee may be required to sit for prolonged periods of time.

Travel

Minimum to no travel is required for this position.

Work from Home

This position may afford the ability to work from work when proficiency levels have been achieved and additional work from home slots are approved.

Education

High School Diploma or equivalency required.
1-2 years of experience in managed care or healthcare insurance is recommended.

Skills/Abilities (preferred)

Ability to maintain strict confidentiality of applicant information in the performance of job functions.
Demonstrated ability to organize work efficiently, evaluate and establish priorities, to handle multiple projects simultaneously.
Demonstrated ability to receive direction, exercise judgment, and make appropriate decisions in handling confidential and time-sensitive documents and information.
Able to present oneself professionally when dealing with public contacts and internal staff.
Able to express oneself clearly and concisely, both verbally and in writing.
Proven experience with Microsoft Office products

Experience in Medicaid, Medicare, and CHIP eligibility process is highly beneficial.

Medicare Advantage Compliance Statement

Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign the Code of Conduct and the Personal Standard Code of Conduct, and are expected to perform their duties ethically and honestly.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc. Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance.

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