Supervisor, Eligibility Systems

3 weeks ago


Rancho Cucamonga, United States Inland Empire Health Plan Full time

Overview:

What you can expect

Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience

Under the direction of the Manager, Eligibility Data, the Supervisor, Eligibility will provide direction, support and leadership to the team supporting Medi-Cal Line of Business (LOB) Member Eligibility data file processing, Member Provider Assignment and Member Correspondence, operational business maintenance, and optimizing Coordination of Benefits (COB) recovery efforts with an understanding of the interrelated dependencies of IEHPs business systems. The Supervisor, Eligibility will ensure that health plan payer hierarchy is maintained by identifying and maintaining third party and coordination of benefits information in the Core Membership system. The Supervisor, Eligibility will partner with business areas across the organization to monitor performance on Medi-Cal metrics, define goals and identify opportunities for improvement and will be responsible for understanding the integrations of enrollment software and core system software, relational databases and IEHPs multiple management systems as it relates to Member Medi-Cal eligibility data processing and regulatory reporting.

Additional Benefits:

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

  • CalPERS retirement
  • 457(b) option with a contribution match
  • Generous paid time off- vacation, holidays, sick
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Paid life insurance for employees with additional options
  • Short-term, and long-term disability options
  • Pet care insurance
  • Flexible Spending Account Health Care/Childcare
  • Wellness programs that promote a healthy work-life balance
  • Career advancement opportunities and professional development
  • Competitive salary with annual merit increase
  • Team bonus opportunities


Qualifications:

Education & Experience

  • Four (4) or more years of experience in a HMO managed care environment in the areas of member eligibility, and/or capitation processing
  • Supervisory/lead capacity experience

Key Qualifications

  • Knowledge of Medi-Cal and Medicare eligibility
  • Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations
  • Knowledge of 834 5010 file format including codes and guidelines
  • Knowledge of eligibility file processing


Work Model Location:

The work location for this position is classified as "telecommute." Telecommute Team Members must be available and willing to work at an onsite IEHP location when requested or as needed.

Start your journey towards a thriving future with IEHP and apply TODAY

Pay Range:
USD $38.49 - USD $44.74 /Hr.

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