Membership Representative (Temporary)
Location: Orange, California US
Job Number: 1813
Position Title: Membership Representative
Alignment Healthcare is seeking a membership representative (temporary) to be responsible for all new plan enrollments. As a membership representative, you will research, validate, and reconcile enrollments from the error reports and Center for Medicare and Medicaid Services (CMS) daily files. You will also ensure all data entry is completed with the require time frame.
General Duties / Responsibilities
(May include but are not limited to:)
- Sending correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections.
- Ensure the TRR is reviewed on a daily basis.
- Submit daily transaction files to CMS.
- Ensure that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).
- All OEV letters are to be logged in the membership data base.
- Act as a liaison to the Sales Representatives. Ensure that new enrollments are processed properly. Provide any issues identified to the necessary internal department heads.
- Data entry of all enrollment applications as well as disenrollments into plan’s data system.
- Track all pending enrollments for additional information needed for qualification.
- Assist 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.
- Submit monthly reports to the Membership Manager, enrollment applications processed and returned, member appointments scheduled, and number of mailed packets and returned mail.
This job has no supervisory responsibilities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Education and / or Experience:
- High school diploma or general education degree (GED);
- or one to three months related experience and / or training;
- or equivalent combination of education and experience.
- Certificates, Licenses, Registrations:
- None required.
- Other Qualifications:
- Knowledge of Medicare Managed Care Plans.
- Two to three years customer service experience.
- Direct sales or related experience preferably in the Managed Care industry.
- Bi-lingual (English / Spanish) required.
Skills and Abilities
- Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Able to speak effectively before groups of customers or employees of the organization.
- Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Able to perform these operations using units of American money and weight measurement, volume, and distance.
- Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.
- Computer Skills: Strong computer skills.
- Other Skills and Abilities:
- Strong organizational skills.
- Good telecommunications skills.
- Attention to detail a must.
Location City: Orange
Location State: California
Community / Marketing Title: Membership Representative (Temporary)
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.