Req ID: 27798BR
POSITION SUMMARY
DE based position supporting State wide Medicaid healthplan. The Enrollment Representative under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.
Fundamental Components:
Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. (*) Monitors daily status reports assessing output for developing trends potentially impacting service levels. (*) Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization. (*) Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports). (*) Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. (*) When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging. (*) Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI). (*) Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.
BACKGROUND/EXPERIENCE desired:
Attention to detail and accuracy. Problem solving skills. Strong organization skills. Understands the impact of work to other teams and downstream support areas. Ability to analyze and research data to make appropriate corrections as necessary. Strong verbal and written communication skills.
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Administration / Operations/Data Entry/1-3 Years
Functional - Administration / Operations/File Maintenance/1-3 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Enrollment - Traditional/1-3 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Eligibility - Traditional/1-3 Years
Functional - Claims/Claims Administration - coordination of benefits (COB) verification/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Aetna Applications/QNXT/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
Technical - Database/Microsoft Access/1-3 Years/End User
REQUIRED SKILLS
General Business/Communicating for Impact/FOUNDATION
General Business/Maximizing Work Practices/FOUNDATION
Service/Demonstrating Service Discipline/FOUNDATION
DESIRED SKILLS
Service/Working Across Boundaries/FOUNDATION
General Business/Demonstrating Business and Industry Acumen/FOUNDATION
Leadership/Collaborating for Results/FOUNDATION
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Claim