Enrollment Service Rep

The Health Plan (THP); Wheeling (WV); On-site; USD 32,000 - 40,000; Full time

Job summary

The Health Plan seeks an Medicare Enrollment Representative to process enrollment and disenrollment requests under CMS guidelines, handle correspondence and reporting, and support Sales during peak periods. The role requires strong communication, accuracy, and confidentiality in a fast-paced environment.

Responsibilities include handling phone inquiries, logging calls, performing enrollment tasks, and coordinating with other units while maintaining PHI security.

Qualifications

• High School Diploma required.
• Typing and computer skills are required.
• Excellent telephone and communication abilities.
• Self-starter with attention to detail and ability to prioritize and meet deadlines.
• Maintain confidentiality and demonstrate mathematical aptitude.
• Strong work ethic and adaptability to changing requirements.

Responsibilities

• Communicate with current and prospective members professionally, accurately and thoroughly.
• Answer prospective sales phone line and route calls to appropriate licensed Sales staff.
• Record all calls accurately in the Customer Service Module or Medicare Call Log.
• Complete a variety of enrollment and disenrollment functions.
• Understand how Enrollment affects other units and departments.
• Assist with the completion of reports in line with CMS requirements (e.g. TRR, BEQs and EDVs).
• Process correspondence and report suspicious issues to Compliance or Management.
• Protect PHI confidentiality for members and staff.
• Overtime may be required to meet CMS timeliness requirements.
• Participate in trainings and maintain a positive and reliable attendance record.
• Assist lobby traffic with Enrollment/Disenrollment questions and concerns.

Skills

Typing and Computer Skills

Telephone and communication skills

Self-starter

Detail oriented

Prioritize and meet deadlines

Maintain confidentiality

Mathematical skills

Good work ethic

Adapt to changes

Education

High School Diploma

Job description

The Medicare Enrollment Representative is responsible for timely processing of enrollment and disenrollment requests using CMS guidelines and policies. They are also responsible for timely completion of all correspondence and reporting functions associated with the Medicare Enrollment Unit and have knowledge of how the Enrollment functions affect other Plan Units and Departments. The Medicare Enrollment Representative provides Sales Support as needed during peak sales periods.

Required

• High School Diploma.
• Typing and Computer Skills.
• Good telephone and communication skills.
• Self-starter, detail oriented, ability to prioritize and meet deadlines.
• Maintain confidentiality.
• Mathematical skills.
• Good work ethic (i.e. adequate learning skills, even temperament, following instructions, retains information., works well with others).
• Easily adapts to changes in work requirement.

Desired

• Familiar with Medicare Enrollment and Disenrollment processes.
• Medical terminology.
• Familiar with CMS Regulations and Guidelines.
• Knowledge of CPT, ICD-9 & ICD-10 coding.

Responsibilities

• Communicate with current and prospective members professionally, accurately and thoroughly.
• Answer prospective sales phone line and route calls to appropriate licensed Sales staff.
• Records all calls accurately in the Customer Service Module or Medicare Call Log.
• Complete a variety of enrollment and disenrollment functions.
• Knowledge of how the Enrollment area functions affect other units and departments.
• Assist with the completion of a variety of reports in accordance with CMS requirements and guidelines (i.e. TRR, BEQs and EDVs)
• Process correspondence.
• Report all suspicious issues to the Compliance Department or Departmental Manager.
• Keep all former, current or prospective members (and other Employee’s) Protected Health Information (PHI) confidential.
• Must be willing to work Overtime if required to meet the CMS timeliness requirements.
• Participate in external and/or internal trainings as required.
• Consistently display a positive attitude and acceptable attendance.
• Assist with lobby traffic for current and prospective members with Enrollment/Disenrollment questions and concerns.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

8:00am - 5:00pm

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