Membership Reconciliation Specialist
Dell - Lincoln, NE

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Dell Inc. is a global provider of information technology solutions. We are currently looking for a Membership Reconciliation Specialist to support our Medicare Advantage Enrollment and Premium Billing services located in Lincoln, Nebraska.

Job Description:
  • Responsible for processing Medicare Advantage and Prescription Drug Plan (MA/MAPD/PDP) membership reconciliations using ikaMedicareGateway.
  • Apply regulations found in the Medicare Managed Care Manual and Plan Communication Users Guide to membership maintenance tasks and file processing (e.g. Transaction Reply Report [TRR], Low Income Subsidy/Late Enrollment Penalty report [LISLEP), Monthly Membership Report [MMR])
  • Utilize Centers for Medicare and Medicaid’s (CMS) MARx system to verify eligibility and research beneficiary statuses.
Responsibilities:
  • Update demographics and other membership information based on data file and case analysis
  • Track and respond to rejected enrollment and disenrollment transactions
  • Research LIS and LEP discrepancies and update systems with correct information
  • Maintain current knowledge of CMS compliance requirements as they pertain to Medicare Advantage enrollment and member maintenance and translating those requirements into actionable solutions
  • Research incomplete and missing information by utilizing several internal systems such as PRISM, MARx, ikaMedicareGateway and Content Manager
  • Prepare retroactive case file for the Retro Processing Contractor (RPC)
  • Identify complex or out of compliance cases for escalation
Required Skills:
  • High school diploma or equivalent required
  • 2+ years applicable Medicare Advantage enrollment and/or reconciliation insurance experience required
  • Strong Microsoft Excel skills required
  • Demonstrable ability to exercise discretion and independent judgment in the resolution of problems and complex technical situations required
Desired Skills:
  • Bachelor’s or Associates degree preferred
  • Experience using ikaSystems, Facets, Market Prominence or similar system preferred
  • Work in a team environment and demonstrate strong attention to detail
  • Demonstrate strong verbal and written communication skills
  • Demonstrate professionalism with peers, subordinates, superiors and customers
  • Manage time and prioritize effectively; demonstrate an ability to cope with a complex and changing environment
Dell offers:
  • Opportunity to work with a strong brand at one of the world's largest IT solutions providers
  • Dynamic, challenging, international work environment
  • A team with a high level of energy, integrity and motivation to win
  • Exciting internal career opportunities
  • A commitment to diversity and inclusion
  • Competitive compensation including bonus plans & a great benefit package
  • An individual professional development plan
About Dell Inc.:
Want to work in an environment where each day is focused on delivering solutions that make a real difference in people’s lives? Where teams are constantly curious, and different perspectives and experiences are valued?

At Dell, we believe technology is essential for human success and that it should be accessible to everyone. We are constantly evolving to better serve our customers, seize new opportunities and drive growth. Together we can change the world. Come join us.

Please visit the About Dell section at www.dell.com for more information.

Dell is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Dell are based on business needs, job requirements and individual qualifications.

Required Skills:
  • High school diploma or equivalent required
  • 2+ years applicable Medicare Advantage enrollment and/or reconciliation insurance experience required
  • Strong Microsoft Excel skills required
  • Demonstrable ability to exercise discretion and independent judgment in the resolution of problems and complex technical situations required
Desired Skills:
  • Bachelor’s or Associates degree preferred
  • Experience using ikaSystems, Facets, Market Prominence or similar system preferred
  • Work in a team environment and demonstrate strong attention to detail
  • Demonstrate strong verbal and written communication skills
  • Demonstrate professionalism with peers, subordinates, superiors and customers
  • Manage time and prioritize effectively; demonstrate an ability to cope with a complex and changing environment
Dell is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind: Dell is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Dell are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. Dell will not tolerate discrimination or harassment based on any of these characteristics
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