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Enrollment Representative

Company: Health New England
Location: Springfield
Posted on: May 14, 2022

Job Description:

Job DescriptionSUMMARY: The Enrollment Representative is responsible to receive, assess, and process enrollment data in accordance with HNE eligibility guidelines, department standards and State and Federal regulations. Maintain membership records in the Amysis database to ensure member information for enrollment and claims processing purposes. Verify data and respond to internal and external inquiries regarding enrollment eligibility. ESSENTIAL FUNCTIONS:

  • Makes decisions regarding the proper method to enroll, dis-enroll or change status for all HNE members in Amysis. The entry decision is based on the employer's contract, HNE eligibility guidelines, and plan policies, procedures and State and Federal guidelines.
  • Collaborates with members, employer groups and various internal departments including Configuration to ensure accurate entry of members. Communicate the entry completion with internal departments and employer groups.
  • Communicates with the Claims Department and other internal departments as appropriate via e-mail, contact sheet or Claimstrack regarding the status of members.
  • Works closely with the Sales Department, Accounting Department, brokers, and employer groups to resolve member enrollment issues.
  • Analyzes and resolves issues received through EDI 834, HNE Direct mailbox, faxes and phone calls.
  • Serves as a resource to Member Services for questions related to a member's eligibility or enrollment status.
  • Coordinates and sends all post enrollment member materials in a timely manner ensuring turnarounds times are met.
  • Provides new employee orientation, support and training regarding member enrollment to internal departments. Conducts formal and informal training related to member setup.
  • Conducts quality checks on work. Ensure efficiency and accuracy of member data and documentation. Continually reviews, edits, and maintains member documentation, data entry sheets, and templates as appropriate.
  • Audits and reconciles membership data from multiple employer groups. MINIMUM REQUIREMENTS:High school diploma or equivalent and at least 2 years of data entry experience preferably within the Managed Care industry.
    • Strong attention to detail and accuracy
    • Very good knowledge of document control and processing procedures
    • PC knowledge preferably with the Microsoft Office Suite
    • Excellent keyboarding skills
    • Strong organizational skills
    • Excellent verbal and written communication skills
    • Strong ability to multi-tasks and effectively balance competing priorities
    • Ability to build effective working relationships internally, as well as with employer groups and members
    • Ability to work independently as well as part of a team

Keywords: Health New England, Springfield , Enrollment Representative, Other , Springfield, Massachusetts

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