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Enrollment Specialist

2 months ago

Miami, United States Solis Health Plans Full time
Job DescriptionJob Description

About us:

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us


Position is fully onsite Monday-Friday.

Location: 9250 NW 36th St, Miami, FL 33178.

**Bilingual in English and Spanish is required**

Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match

Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to almost 7,000 members in the last year

Join our winning Solis Team


POSITION SUMMARY

Responsible for the processing of new enrollment applications and updating current member profile changes in accordance with CMS and State regulations.


ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Handles receiving, controlling, and processing enrollment and disenrollment elections from Medicare beneficiaries, as well as any required updates to a member record.
  • Audits data entered into the plans internal systems to ensure data integrity and quality.
  • Uses judgment and informed decision-making to determine appropriate actions on elections and in handling discrepancies.
  • Transmits election information to CMS within specified timeframes and according to CMS regulations.
  • Ensures appropriate letters are sent to members within CMS timeframes.
  • Conducts outbound calls to confirm and verify mailing addresses, permanent residency.
  • Sorts returned mail and prepares mail with corrected addresses.
  • Analyzes and interprets out of area indicator reports submitted by CMS and determine action to be taken.
  • Place materials into storage receptacles, such as file cabinets, boxes, bins, or drawers, according to classification and identification information.
  • Reads and scans all incoming materials to determine how and where they should be classified or filed.
  • Sort or classifies information according to guidelines, such as content, purpose, user criteria, or chronological, alphabetical, or numerical order.
  • Eliminates outdated or unnecessary materials, destroying them or transferring them to inactive storage, according to file maintenance guidelines or legal requirements.
  • Performs periodic inspections of materials or files to ensure correct placement, legibility, and proper condition.
  • Input data, such as file numbers, new or updated information, or document information codes into computer systems to support document and information retrieval.
  • Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
  • Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.


QUALIFICATIONS & EDUCATION

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.

  • High school graduate or equivalent and one (1) year Medicare, Medicaid, managed care or other health/insurance related experience; or equivalent combination of education and experience.
  • Data entry skills a must.
  • Excellent organizational skills, customer services skills, listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization.
  • Excellent computer knowledge is required, including proficient knowledge of Microsoft Office.
  • Familiarity with healthcare laws, regulations, and standards.
  • Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations.
  • Ability to continually display a positive attitude and follow directions.
  • Ability to multitask, prioritize, carry out tasks thoroughly, and meet deadlines.
  • Must be patient dealing with an elderly population and sympathetic to hearing or vision deficiencies.
  • Ability to read, analyze, and interpret technical procedures or governmental regulations.
  • Ability to write reports, business correspondence, and procedure manuals.
  • Ability to effectively present information and respond to questions from group of managers, clients, customers and the general public.
  • Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages area and volume.
  • Ability to define problems, collect data, establish facts, and draw valid conclusions.
  • Must be able to work in a fast paced environment.
  • Fluency in Spanish and English required.

What set us apart:

Join Solis Health Plans as an Enrollment Specialist and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference