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Customer Solution Center Enrollment Services Representative II
1 month ago
Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11432 Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members in five health plans, ensuring our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. The Customer Solution Center Enrollment Services Representative II is responsible for auditing, researching, updating, and maintaining member data integrity in the core system, including provider and plan partner assignments, member demographics, and troubleshooting complex issues for all lines of business. This position audits inbound eligibility file load errors, intake forms, and e-mail requests; makes recommendations or updates member information and other related transactions as needed within the timeframe outlined in the company policies and procedures. Collaborates with internal/external departments to ensure timely resolution to member issues and member access to care. Assists with user acceptance testing (UAT) related to system and/or process defects and issues. Provides support and ownership of any escalated and/or complex issues related to member coverage preventing member access to care. Duties Daily audit inbound eligibility load errors, intake form and e-mail requests related to member coverage, provider and plan partner assignments, and manual updates to member demographics and other related transactions preventing member access to care. Support internal/external departments and make recommendations as needed. (20%) Timely processing of work assignments and maintain accuracy of provider and plan assignments as outlined in the company policies and procedures. (60%) Assist the department in user acceptance testing (UAT) to improve/enhance processes. (5%) Assist the department in the development of desktop level procedure (DLP). (5%) Perform other duties as assigned. (10%) Education Required Education Preferred Experience Required: Minimum of 1 year of member eligibility data experience in a healthcare environment. Experience with and knowledge of Medi-Cal, Medicare, Market Place/Exchange, Commercial and Individual product lines, and other related government-funded/sponsored healthcare programs. Preferred: Previous experience in Managed Health, preferably in Customer Service, Enrollment Services, or Claims. Skills Required: Strong research, auditing, multi-tasking, problem-solving, and verbal/written communication skills. Intermediate computer skills including MS Office Suites as well as member processing systems such as QNXT or MHC. Preferred: Knowledge in MARx and AEVS. Knowledge in 834, TRR, HCO, or RTZ member eligibility electronic files. Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. (English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.) Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including: Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Nearest Major Market: Los Angeles Job Segment: Customer Service Representative, Claims, Medicare, Customer Service, Healthcare, Insurance #J-18808-Ljbffr
