The Medicare membership specialist is responsible for processing, maintaining and reconciling all of Independent Health’s Medicare Advantage membership records in the appropriate insurance platform. The specialist is responsible for maintaining knowledge of all CMS rules and regulations for enrollment, disenrollment and reconciliation ensuring overall plan compliance. The specialist is accountable to document and resolve all enrollment elections that are missing information by contacting the member, employer, 3 rd party as necessary. The specialist is accountable for directly supporting all internal sales and service centers by researching and resolving eligibility and membership issues. The specialist will participate in the management and processing of the electronic enrollment transfer of membership records to the claims platform. Over time and holiday work may be required during high peak periods to meet timeframes.
Two (2) year degree from an accredited institution or four (4) years equivalent education/experience in business related field.
Three (3) years data entry processing required, health care industry experience preferred.
Three (3) years customer service type experience including business to business account servicing type role with demonstrated proficiencies in servicing outcomes and leadership skills.
Demonstrated ability to work independently under strict deadlines, maintain confidentiality and make decisions commensurate with position responsibilities.
Demonstrated ability to understand and articulate complex systems, process and/or concepts and influence outcomes through clear and effective communication and collaboration.
Demonstrated ability to work collaboratively with others at all levels of an organization, internally and externally to achieve common goals.
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.
Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Independent Health reserves the right to change job descriptions as necessary.
Independent Health is an equal opportunity employer.