Enrollment Specialist

Medicare Advantage Health Plan Miramar, Florida Park Ridge, Illinois


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina through our affiliate, Eon Health.

Job Summary:

The Enrollment Specialist conducts procedures related to the submission of member data and review of regularly received reports from CMS.

Main Accountabilities:

  • Processing of Medicare enrollments, disenrollments, cancellations, including application data entry.
  • Applies CMS rules and reviews CMS system(s) to make eligibility determinations.
  • Transaction Reply Report (TRR) Processing.
  • Monitors and processes work queues and routine error reports to resolve errors that arise during application processing.
  • Makes outbound enrollment-related calls.
  • Audits outbound correspondence for accuracy, processes simple inbound correspondence (e.g. address changes, enrollment and disenrollment cancellations), investigates returned mail, manually updates the MA billing and enrollment system, and generates outbound correspondence with limited variable language/free form text.
  • Retrieves and compiles documents needed for case files related to enrollment data validation and retroactive changes to the RPC
  • Daily tasks include: ongoing incoming and outgoing phone calls; ongoing incoming and outgoing email; ongoing use of member database and members’ electronic medical records; processing paper mail; and processing faxes.
  • Respond to and answer all member and provider inquiries in a courteous, responsive, and timely manner following all departmental and organizational policies and procedures.
  • Use call tracking systems to document communication with members and providers.
  • Coordinate mailing of member materials as needed.

Knowledge & Skills:

  • Must possess exceptional oral and written communication skills, including the ability to manage difficult callers and conflict.
  • Ability to multi-task, good organizational and time management skills.
  • Analytical skills in research and problem resolution.
  • Strong computer skills (keyboard proficient, quick data entry with a high level of accuracy).
  • Able to work cooperatively with other departments.
  • Multi-task oriented with the ability to prioritize.
  • Well organized with excellent follow up skills.
  • Strong communication skills, basis computer skills (verbal and written).
  • Analytical ability with an affinity to detail, as well as the capability to handle heavy workloads and meet deadlines.
  • Must be able to work and act independently and be self-directed.

Requirements:

  • Minimum 1-2 years prior customer service experience is preferred or related experience.
  • Minimum Education: High School/GED required, Bachelor’s degree preferred.
  • An understanding of the health insurance industry is preferred.