Enrollment Representative (44382)

Under direct supervision, is responsible for a variety of specific functions associated with enrollment and reconciliation transactions to facilitate accurate enrollment data. He/she processes enrollment data within a timeframe and at a performance level that ensures members timely access to benefits and accurate processing of claims. He/she will compile the eligibility discrepancies in a timely manner to ensure that members are able to obtain health services appropriately. He/she also works collaboratively with various internal departments to resolve complex issues related to member eligibility and provider discrepancies to meet the Mission, Vision and Values of Neighborhood.

Duties and Responsibilities

Responsibilities may include, but are not limited to, the following:

• Maintain membership eligibility information in system
• Generate membership correspondence
• Produce enrollment activity reports for internal and external customers
• Interact with internal and external contacts regarding membership and eligibility issues
• Reporting and billing of births
• Manual data entry of newborns, exception reports and daily spreadsheets
• Provide enrollment information to internal customers about enrollment issues
• Act as secondary contact in communicating with EOHHS, HP, DCYF and/or HSRI to resolve enrollment issues
• Communicate to the Member Services department the status of enrollment processes
• Support and work collaboratively with the next level analysts in handling some tasks related to Coordination of Benefits, including research, outreach and reporting
• Provide back up to the next level analysts in a limited scope
• Maintaining absolute file integrity with regards to content, location and confidentiality
• Participate in training and development
• Identify opportunities for process improvements and workflow efficiencies
• Other duties as assigned