Enrollment Specialist I - Temporary (On-site)

UPMC; Erie (Erie County); On-site; USD 23,000 - 32,000; Part time

Job summary

UPMC Health Plan is seeking a Temporary Enrollment Specialist I in the Medicare Enrollment department for an on-site role in Erie, PA. The position pays $20/hour and follows a Monday–Friday daylight schedule with overtime as needed.

The Enrollment Specialist will create and maintain eligibility in the transactional system, respond to inquiries from internal and external customers, and resolve issues to meet service requirements while adhering to CMS, DPW, and PID regulations.

Qualifications

• Six months of customer service and/or call center experience.
• Ability to interpret and apply complex eligibility regulations (CMS/DPW/PID).
• Strong organizational and communication skills.
• Attention to detail and ability to multitask.

Responsibilities

• Process enrollment/disenrollment transactions in accordance with policies and regulations.
• Generate and mail/electronic letters to members as required.
• Maintain confidentiality of employee/insured information.
• Analyze data to determine eligibility and election periods.
• Collaborate with Sales to collect required data for applications.
• Stay up to date with CMS/DPW/PID regulations and guidance.
• Respond to inquiries from internal and external customers in a timely manner.
• Meet production and quality goals.

Skills

Customer service

Call center

Analytical thinking

Education

High school diploma

College degree

Tools

MS Office

Job description

UPMC Health Plan has an exciting opportunity for a Temporary Enrollment Specialist I position in the Medicare Enrollment department. This is a temporary position working Monday through Friday daylight hours and will be an on-site position located in Erie, PA.

This position has a set rate of $20/hr.

Schedule: Monday- Friday, between 7 a.m.- 5 p.m. Overtime required based on business needs.

The Enrollment Specialist will be responsible for the creation and maintenance of eligibility in the transactional system, responding to both internal and external customer inquiries, and resolving issues to meet or exceed service requirements. To successfully perform the role, an Enrollment Specialist must have a comprehensive understanding of enrollment regulations and complete all duties with strict regard to policies and procedures. Completes all duties with strict regard to policies and procedures set forth by Enrollment Services Manager, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID). Performs duties related to the processing and maintenance of all member requested transactions, include generation of required letters to ensure enrollment and/or disenrollment processes are completed compliantly. Interacts with both internal and external customers to address and resolve inquiries or complaints.

Responsibilities:

• Understanding of varied and detailed enrollment and disenrollment requirements and processing rules based upon the product (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group, including, but not limited to, understanding and application of service areas by product.
• Maintain employee/insured confidentiality.
• Ability to analyze information to make appropriate decisions regarding enrollment/disenrollment, complying with applicable regulations and governance.
• Interact with Sales staff to ensure all required date elements for completed application are received and any issues are addressed timely, in accordance with compliance requirements.
• Ability to make eligibility determinations based on CMS (Part A/Part B Eligibility), DPW (Medical Assistance Eligibility), and/or PID requirements, in accordance with the application election period guidelines.
• Ability to accurately identify appropriate election period based upon analysis of beneficiary/member history and regulatory guidance.
• Comprehension and application of eligibility regulations to process enrollment transactions and generation of corresponding letters to members.
• Must keep up to date with new regulations and guidance.
• Process all types of enrollment and disenrollment transactions in accordance with company policies and procedures in a timely manner while meeting production and quality goals.
• Initiation and generate of appropriate correspondence based on type of transaction processed, includes initiation of outreach requests and written correspondence (letters), as necessary.
• Daily clerical responsibilities related to processing and electronic storage of member correspondence.
• Identify areas of concern or trends that may compromise client satisfaction or compliance with government regulations.
• Support team projects within Enrollment Services; other projects as assigned.
• High school graduate or equivalent required, college degree preferred.
• Minimum of six months of customer service and/or call center experience.
• Ability to interpret and apply complex eligibility regulations as mandated by CMS, DPW, and PID.
• Demonstrates good organizational, interpersonal, leadership and communication skills.
• Attention to detail is critical to the success of this position, with skills in customer orientation.
• Will need to manage multiple tasks and projects.
• MS Office/PC skills required.

Licensure, Certifications, and Clearances:

• ACT 34

UPMC is an Equal Opportunity Employer/Disability/Veteran