Member Representative

Orange, CA | Temp-to-Hire

Job ID: [SA] Member Representative Industry: Healthcare Pay Rate: 17.00

Membership Representative (Contract to Hire)

The Membership Representative is responsible for all new plan enrollments. Researching validating and reconciling enrollments from the error reports and CMS (Center for Medicare and Medicaid Services) daily files. Ensures all data entry is completed with the require time frame.

 

Experience needed:

  • Medicare Advantage Prescription Drugs (MAPD)
  • Medicare Enrollment Experience
  • Chapter 2 Medicare Advantage Experience
  • Sending correspondence to Members or Center for Medicare and Medicaid Services (CMS) to gather information or provide updates for corrections. 
  • Submit daily transaction files to CMS.
  • Ensure that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).
  • All OEV letters are to be logged in the membership data base.
  • Act as a liaison to the Sales Representatives.  Ensure that new enrollments are processed properly.  Provide any issues identified to the necessary internal department heads.
  • Data entry of all enrollment applications as well as disenrollments into plan’s data system.
  • Track all pending enrollments for additional information needed for qualification.

 

 

 

 

  1. Knowledge of Medicare Managed Care Plans.
  2. Two to three years customer service experience.
  3. Direct sales or related experience preferably in the Managed Care industry.
  4. Bi-lingual English/Spanish preferred
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