Enrollee Care Navigator – NaviCare Specialist

Fallon Community Health Plan, Inc.; Worcester (MA); In loco; USD 26.000 - 36.000; Tempo pieno

Descrizione del lavoro

Fallon Health in Worcester, MA seeks an Enrollee Service Representative to handle Medicare and Medicaid benefit inquiries, enrollment questions, and member concerns within the NaviCare program, ensuring timely, accurate responses.

You will serve as a liaison between enrollees and Fallon Health, collaborate with outreach and enrollment teams, and use tools like QNXT, TruCare, and RingCentral to deliver high-quality service while protecting confidential information in a fast-paced environment.

Competenze

• Bachelor’s degree or equivalent combination of education and experience.
• 1–3 years of related healthcare experience is preferred.
• Ability to communicate and present information to various levels of personnel.
• Excellent interpersonal skills and ability to negotiate with customers and remain diplomatic.

Mansioni

• Provides coverage for the NaviCare enrollment ACD line and handles Enrollees inquiries.
• Actively engage in onboarding training to learn essential systems, policies, and procedures.
• Serves as a subject matter expert in the NaviCare product and benefits.
• Demonstrate knowledge of enrollment and disenrollment processes and regulations per SCO contract and related CMS guidelines.
• Assists enrollees with inquiries related to Medicare and Medicaid benefits.
• Supports the outreach and enrollment teams as a resource.
• Handles enrollees' billing issues and presents them to NaviCare Clinical Directors or other reviewers.
• Assist contracted providers with pending claims issues.
• Ability to protect confidential/privileged patient and proprietary information.
• Ability to function effectively in a fast-paced environment with competing priorities.
• Ability to synthesize regulatory requirements for NCQA, CMS and SCO contract.
• Adhere to quality standards for call handling, documentation, and off-phone work.

Conoscenze

Communication skills

Interpersonal skills

Diplomacy

Adaptability

Formazione

Bachelor’s degree

Strumenti

QNXT

TruCare

RingCentral

Descrizione del lavoro

Fallon Health in Worcester, MA seeks an Enrollee Service Representative to handle Medicare and Medicaid benefit inquiries, enrollment questions, and member concerns within the NaviCare program, ensuring timely, accurate responses.

You will serve as a liaison between enrollees and Fallon Health, collaborate with outreach and enrollment teams, and use tools like QNXT, TruCare, and RingCentral to deliver high-quality service while protecting confidential information in a fast-paced environment.