Membership Representative Bilingual Spanish

Orange, CA 92868

Employment Type: Temporary Category: Healthcare Job Number: [SA] Pay Rate: 16.00

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. 

Essential Duties and Responsibilities

Essential duties and responsibilities include but are not limited to: 

  1. Sending correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections. 
  2. Ensure the TRR is reviewed on a daily basis.
  3. Submit daily transaction files to CMS.
  4. Ensure that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).
  5. All OEV letters are to be logged in the membership data base.
  6. 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.
  7. Data entry of all enrollment applications as well as disenrollments into plan’s data system.
  8. Track all pending enrollments for additional information needed for qualification.
  9. Assist in the departmental compliance tasks which include the Working Aged Survey Mailing, Annual Notice of Change Letter, Health Care Risk Assessment mailings, and all other necessary compliance mailings.
  10. Submit monthly reports to the Membership Manager, enrollment applications processed and returned, member appointments scheduled, and number of mailed packets and returned mail.

 

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Education and/or Experience:  High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

Other Qualifications:

  1. Recent Medicare/Healthcare experience.
  2. Knowledge of Medicare Managed Care Plans.
  3. 2-3 years healthcare customer service experience.
  4. Chapter 2 knowledge
  5. Minimum data entry of 40wpm
  6. Direct sales or related experience preferably in the Managed Care industry.
  7. Bi-lingual (English/Spanish) required. 
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