Hybrid Enrollment Representative (Orange, CA)

E2E Alignment Healthcare USA, LLC; California (MO); Hybrid; USD 42,000 - 58,000; Full time

Job summary

Alignment Health in the United States seeks an Enrollment Representative to manage new plan enrollments, validate data, and ensure CMS compliance. You will work with Sales and Compliance teams to process enrollments and resolve issues efficiently.

The role requires strong customer service, familiarity with Medicare guidelines, and effective communication. A bilingual English/Spanish candidate is preferred; high school diploma or GED is required.

Qualifications

• Minimum 2 years of customer service experience.
• Direct sales or related experience preferably in the Managed Care industry.
• High School Diploma or GED required; Bachelor's degree or four years additional experience in lieu of education.
• MBA preferred.

Responsibilities

• Sends correspondence to Members or CMS to gather information or provide updates for corrections.
• Ensures the TRR is reviewed on a daily basis.
• Submits daily transaction files to CMS.
• Ensures that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).
• Acts as a liaison to the Sales Representatives. Ensures that new enrollments are processed properly. Provides any issues identified to the necessary internal department heads.
• Conducts data entry of all enrollment applications as well as disenrollments into plan's data system.
• Tracks all pending enrollments for additional information needed for qualification.
• Assists 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.
• Submits monthly reports to the Membership Manager, enrollment applications processed and returned, member appointments scheduled, and number of mailed packets and returned mail.

Skills

Customer service

Bi-lingual English/Spanish

Medicare knowledge

Education

High School Diploma or GED

Bachelor's degree or 4 years additional experience in lieu

MBA

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail.

It takes an entire team of passionate and caring people, united in our mission to put the senior first.

We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.

In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community.

Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The hybrid Enrollment 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.

Responsibilities:

1. Sends correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections.
2. Ensures the TRR is reviewed on a daily basis.
3. Submits daily transaction files to CMS.
4. Ensures that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).
5. Acts as a liaison to the Sales Representatives. Ensures that new enrollments are processed properly. Provides any issues identified to the necessary internal department heads.
6. Conducts data entry of all enrollment applications as well as disenrollments into plan's data system.
7. Tracks all pending enrollments for additional information needed for qualification.
8. Assists 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.
9. Submits monthly reports to the Membership Manager, enrollment applications processed and returned, member appointments scheduled, and number of mailed packets and returned mail.

Job Requirements:

Experience:

• Required: Minimum 2 years of customer service experience.
• Preferred: Direct sales or related experience preferably in the Managed Care industry.

Education:

• Required: High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.
• Preferred: MBA

Specialized Skills:

Required: Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Knowledge of Medicare Managed Care Plans. Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

Language Skills:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Mathematical Skills:

Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.

Reasoning Skills:

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Problem-Solving Skills:

Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Preferred: Bi-lingual (English/Spanish)

Licensure:

Required: None

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $41,600.00 - $57,600.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

Alignment Health is championing a new path in senior care that empowers members to age well and live their most vibrant lives. Our mission-focused team makes high-quality, low-cost care a reality for members every day. Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. We believe that great work comes from people who are inspired to be their best. We've built a team of people who want to make a difference in the lives of the seniors we serve. Come join the team that is changing health care - one person at a time.