Medicare Enrollment Specialist

The Medicare Enrollment Specialist position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, OH Medical Mutual office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Medical Mutual’ s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

Under general supervision, processes routine to moderately complex Medicare enrollment and disenrollment requests, evaluates eligibility, generates correspondence, and makes outbound enrollment-related calls. Ensures proper documentation for all work and a sufficient audit trail.

Responsibilities

Medicare Enrollment Specialist

• Data enters routine to moderately complex paper Medicare enrollments and disenrollments and cancellations, including application data entry. Applies CMS rules and reviews CMS system(s) to make eligibility and creditable coverage determinations. Processes routine to moderately complex error reports to resolve errors that arise during application processing.

• Makes scripted outbound enrollment-related calls, where deviation from the standard script may be needed in response to Medicare beneficiary questions about the topics covered in the outbound call. Makes outbound calls using standard/scripted talking points and department procedures and applies CMS rules in order to address Medicare beneficiary inquiries.

• Audits outbound correspondence for accuracy, processes simple inbound correspondence (e.g. address changes, enrollment and disenrollment cancellations), investigates returned mail, manually updates the MA billing and enrollment system, and generates outbound correspondence with limited variable language/free form text.

• Retrieves and collates documents needed for case files related to enrollment data validation and retroactive changes to the RPC .

• Performs other duties as may be assigned from time to time.

Sr. Medicare Enrollment Specialist

• Processes routine to varied and/or complex paper and electronic Medicare enrollments and disenrollments, including application data entry, generation of outbound correspondence and submissions to Centers for Medicare & Medicaid Services (CMS) and retroactive processor (RPC) review. Applies CMS rules and reviews CMS system(s) to make eligibility and creditable coverage determinations and support the resolution of errors that arise during application processing.

• Makes outbound enrollment related calls to request further information needed to complete enrollment process. May be required to deviate from standard scripts and apply knowledge of CMS rules in order to address member inquiries or concerns.

• Reviews daily CMS reports to ensure accuracy in automated processing of daily CMS reports, manually generates outbound correspondence, manually updates MA billing and enrollment system, and takes other appropriate actions, as necessary. Reviews varied and/or complex daily and monthly reports to identify and correct errors and discrepancies in enrollment.

• Reviews correspondence returned mail and requests for investigation and/or action from beneficiaries and other departments, investigates, responds to issues and takes actions accordingly, or routes to proper area for completion. Maintains proper documentation for historical reference and audit purposes.

• Orients, trains, and assists more junior level staff.

• Prepares enrollment data validation and packets for submission to RPC .

• Performs other duties as assigned.

Qualifications

Medicare Enrollment Specialist

Education and Experience:

• Associate’s Degree in Business or Healthcare Administration, Human Services, Communications, or related field, or equivalent combination of training and experience.

• 2 years customer service experience in health insurance, health care, or related industry, preferably in a call center environment.

• Medicare Advantage and/or Part D experience preferred.

Technical Skills and Knowledge:

• Knowledge of Medicare Advantage and/or Part D programs.

• Strong communication and customer service skills.

• Ability to understand and communicate plan designs, complex CMS rules and procedures in a simple and concise manner to Medicare beneficiaries.

• Knowledge of health insurance and managed care terminology.

• Intermediate proficiency with internet and database navigation, Microsoft Office applications, and health insurance operations systems; must be able to create and update excel documents.

• Solid data entry skills.

• Solid arithmetic skills.

Sr. Medicare Enrollment Specialist

Education and Experience:

• Bachelors’ Degree in Business or Healthcare Administration, Human Services, Communications, or related field preferred, but will consider collective experience, training and education.

• 3 years’ experience as a Medicare Enrollment Specialist or equivalent progressive experience in a customer facing role in health insurance, health care, or related industry, which includes applying complex regulatory rules in an operations environment.

• Medicare Advantage experience preferred.

Technical Skills and Knowledge:

• Strong knowledge of Medicare Advantage and Part D enrollment rules and regulations and the ability to apply in an operations environment.

• Strong communication and customer service skills with a focus on member retention.

• Ability to understand and communicate plan designs, complex CMS rules and procedures in a simple and concise manner to Medicare beneficiaries.

• Knowledge of health insurance and managed care terminology.

• Strong investigatory, critical thinking and problem solving skills.

• Intermediate to advanced proficiency with internet and database navigation, Microsoft Office applications, and health insurance operations systems; must be able to create and update excel documents.

• Solid data entry skills.

• Ability to interpret documents of varied complexity.

Medical Mutual is looking to grow our team We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• Top Workplace in Northeast Ohio. Year after year we've received this recognition

• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes

• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations

• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member

• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans

• Employee bonus program

• 401(k) with company match and an additional company contribution

• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes

• Mentoring and coaching to help you advance

• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Title: Medicare Enrollment Specialist

Location: OH-Brooklyn

Requisition ID: 2400320