Medicaid Coverage & Eligibility Verifier

SGS Consulting; Athens (GA); Vor Ort; USD 42.000 - 58.000; Vollzeit

Zusammenfassung

SGS Consulting is hiring for an Enrollment Specialist in Georgia to assist Medicaid-eligible recipients with HIPP/Premium Assistance. You will verify existing coverage, gather required documents, and manage open enrollment and premium payments.

Responsibilities include identifying eligible members, maintaining case files, and handling high volumes of inquiries. Strong customer service and health insurance knowledge are required.

Qualifikationen

• Experience in health insurance verification and patient/customer support.
• Familiarity with Medicaid rules and enrollment processes.
• Solid customer service skills and ability to multi-task in a fast-paced environment.

Aufgaben

• Provide enrollment assistance and guidance to Medicaid-eligible recipients and their families regarding the HIPP / Premium Assistance program via phone or correspondence.
• Verify, document, and investigate existing health coverage for Medicaid recipients and their dependents (employer plans, COBRA, etc.).
• Assist in identifying members who may qualify for HIPP / Premium Assistance.
• Obtain and verify documents required for eligibility: insurance policies, employment verification, premium invoices, etc.
• Maintain active case files during open enrollment cycles, premium review, and payment processing.
• Process, review, and follow up on premium payments / reimbursements, ensuring timely and accurate payments, and tracking any discrepancies.
• Perform ongoing case maintenance and audits, updating records for status changes, renewals, terminations, or escalations.
• Complete periodic reporting (e.g. case metrics, enrollment trends, audit reports) as required by state or internal stakeholders.
• Respond to high volumes of inbound and outbound calls and inquiries about eligibility, coverage, program rules, and status.
• Conduct advanced document review, legal research or case escalation as needed, particularly on more complex cases.
• Prioritize case events, manage deadlines, escape issues to supervisors or subject matter experts when appropriate.
• Substantial customer service experience, ability to multi-task in a fast-paced environment, basic knowledge of health insurance and health insurance terminology, Excel Microsoft knowledge.

Kenntnisse

Insurance Verification

Health Insurance

Medicaid Verification

Customer Service

HIPPA

Ausbildung

Some college desirable; Bachelor's preferred but not required

Jobbeschreibung

SGS Consulting is hiring for an Enrollment Specialist in Georgia to assist Medicaid-eligible recipients with HIPP/Premium Assistance. You will verify existing coverage, gather required documents, and manage open enrollment and premium payments.

Responsibilities include identifying eligible members, maintaining case files, and handling high volumes of inquiries. Strong customer service and health insurance knowledge are required.