Enrollee Services Representative

3 weeks ago


Maryland Line, United States Ageatia Global Solutions Full time
PRINCIPAL ACCOUNTABILITIES:
Enrollee Service Representatives serve as Enrollee and Provider advocates who provides guidance, assistance and education to Enrollees, caregivers, and providers answering basic question regarding Enrollee health care needs, benefits and effectively resolve issues raised by Enrollees primarily through inbound calls.
Under the direct supervision of the Manager of Enrollee Services, the Enrollee Services Representative is responsible to:
  • Provide adequate customer service to our enrollees, vendors and providers
  • Identify callers concerns and provide resolution for the inquiry
  • Assist enrollees with a request to change or select a PCP (Primary Care Provider)
  • Re-issue enrollee ID cards as requested
  • Assist enrollees with questions related to their benefit plan
  • Obtain and update demographic information
  • Assist Enrollees face to face who walk-in the office
  • Assist irate callers to resolve their issue
  • Assist Enrollees with filing a grievance and forwarding to the appropriate department
  • Document all interactions with callers
  • Interact with pharmacies when appropriate
  • Identify trends with enrollees and providers that can affect daily operations
  • Process return mail, enrollee cards and packets
  • Facilitate special transportation request
  • Provide clarity to providers on basic claim questions
  • Educate providers on internal processes for claims, authorization, and appeal/grievance submission
  • Confirm the status of a claim (paid/denied)
  • Direct providers to appropriate internal departments for further assistance
  • Confirm eligibility and PCP assignments to providers and contracted vendors
  • Follow company and department policies and procedures
  • Meet department call center goals for abandonment rate, service level and speed of answer
  • Participate in community events
  • Other duties as assigned
Required Experience/Skills/Abilities:
  • Minimum two (2) years of call center experience
  • Experience with health care benefits or DC Medicaid, Managed Care experience preferred
  • MHC preferred
  • Experience with Facility and Professional audits of claims
  • Knowledge of ICD-10 and HCPC codes, Client, Emdeon and eligibility tools
  • Proficient in Microsoft Office tools (Excel, PowerPoint)
  • High level understanding of the claims process.
  • High School Diploma or GED
  • Call Center experience, Medical Insurance background (a plus but not required), Bilingual (a plus but not required)


  • Maryland Line, United States Rich Products Full time

    Rich's, also known as Rich Products Corporation, is a family-owned food company dedicated to inspiring possibilities. From cakes and icings to pizza, appetizers and specialty toppings, our products are used in homes, restaurants and bakeries around the world. Beyond great food, our customers also gain insights to help them stay competitive, no matter their...


  • Maryland Heights, Missouri, United States teamworkonline Full time

    OverviewCustomer Service Representative is responsible for the Front Information Desk. This is where the Customer Service Representative can be most effective to greet our guests, answer questions, check in vendors, accept and log deliveries, answer incoming telephone calls, maintain lost and found items, accept payment(s) for programs, events and...


  • Maryland Heights, United States Lexicon Services Full time

    Job DescriptionJob DescriptionClient Contact RepresentativeWe are seeking a highly motivated and driven individual to join our team. The Client Contact Representative is responsible for answering incoming communications for Lexicon and its clients, scheduling initial appointments for prospective clients, and maintaining a neat and professional office...


  • Maryland Line, United States PMA Companies Full time

    Job Description: As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with...


  • Maryland Line, United States Ageatia Global Solutions Full time

    Responsibilities: * This position ensures that accounts are accurately and timely enrolled, billed, and reconciled so that the system is correct and the client is satisfied. In accomplishing its accountabilities, the position must interact and coordinate with accounts, subscribers, sales, underwriting, finance, systems, other Blues plans' account...


  • Maryland Heights, United States Weather Barr Windows and Doors Full time

    WeatherBarr Windows and Doors is looking to hire an Administrative Assistant/Customer Service Representative to work Full Time at our Maryland Heights, MO branch. *APPLICANTS MUST COMPLETE THE ONE-WAY VIDEO INTERVIEW TO BE CONSIDERED FOR THIS POSITION. THE VIDEO LINK WILL BE SENT TO YOUR EMAIL AFTER COMPLETION OF YOUR APPLICATION.* The starting hourly wage...


  • Maryland Line, United States Washington Metroplitan Area Transit Authority Full time

    Job Description On-Site Work Statement: This is an on-site/in-person work opportunity. Marketing Statement: The Washington Metropolitan Area Transit Authority (WMATA) Occupational Health and Wellness (OHAW) Department is seeking an experienced Medical Director, Clinical Services, who will be responsible for delivering specialty care with a high degree of...

  • HelpDesk Specialist

    6 days ago


    Maryland Line, United States Marathon TS Full time

    Marathon is seeking a Helpdesk Specialist Senior to support the MDOT State Highway Administration (SHA). Candidate will monitor and coordinate all data system operations, including security procedures, and liaison with end users. Ensure that necessary system backups are performed and storage and rotation of backups is accomplished. Monitor and maintain...

  • Retail Representative

    18 hours ago


    Center Line, United States Jars Cannabis Full time

    Job DescriptionJob DescriptionJARS CANNABISwww.shopjars.com - Michigan's Leading Cannabis Retailer Ready to elevate your career path to a new all-time high?JARS Cannabis is more than just your average cannabis brand and retailer. We are a culturally inspired organization on a mission to rewrite the existing narratives that surround cannabis, one...

  • Massage Therapist

    2 weeks ago


    Maryland Line, United States TEAM FX Full time

    FX Studios is committed to providing exceptional customer service to each and every guest. We want each guest's experience to be nothing less than exceptional! The Massage Therapist is a direct representation of FX Studios and provides a critical role in the guests' impression of our brand. Every Service Provider's role is to create an exceptional experience...


  • Center Line, United States Binson's Hospital Supplies Inc. Full time

    Job DescriptionJob DescriptionAs an industry-leading health care organization, our mission is to provide our communities with “Better Products, Better Services, Better Lives.” We are a dynamic, growing, family-owned company with locations in Michigan, Indiana and Florida. Join our team at Binson’s Medical Equipment & Supplies today! WHAT WE'RE...


  • Maryland Line, United States Medstar Full time

    General Summary of PositionThe Director of Partnerships is the strategic and relationship lead for MedStar Health's entire sports partnership portfolio. This includes professional teams, colleges/universities, athletic events (i.e. running festivals), high schools, and community/recreational partnerships. Responsible for supporting growth in MedStar Health...


  • Maryland Line, United States Medstar Full time

    General Summary of Position The Director of Partnerships is the strategic and relationship lead for MedStar Health's entire sports partnership portfolio. This includes professional teams, colleges/universities, athletic events (i.e. running festivals), high schools, and community/recreational partnerships. Responsible for supporting growth in MedStar Health...


  • Maryland Heights, United States Weather Barr Windows and Doors Full time

    Job DescriptionJob DescriptionWeatherBarr Windows and Doors is looking to hire an Administrative Assistant/Customer Service Representative to work Full Time at our Maryland Heights, MO branch.*APPLICANTS MUST COMPLETE THE ONE-WAY VIDEO INTERVIEW TO BE CONSIDERED FOR THIS POSITION. THE VIDEO LINK WILL BE SENT TO YOUR EMAIL AFTER COMPLETION OF YOUR...


  • Maryland Heights, United States TEKsystems Full time

    Description: OVERVIEW: The primary purpose and function of this position is to support our client's B2B customer base, outside sales representatives and senior management. ESSENTIAL DUTIES AND RESPONSIBILITIES: •Field incoming customer calls. •Provide complete, professional responses to internal / external customer inquiries. •Enter, modify,...


  • Maryland Line, United States KI Full time

    At KI, we believe knowing our customers helps us serve them better. We listen. We observe. We understand that each customer has unique needs. So, we pride ourselves on helping our customers make smart furniture decisions by offering expert advice, design options and personalized solutions.Since 1941, we've positioned KI as the furniture company that best...


  • Maryland Line, United States Parallel LLC Full time

    About This Role Are you ready to make a difference? Come work with Parallel! We're searching for an experienced Speech-Language Pathologist (SLP) to join our team! Our ideal candidate has a passion for supporting families and children with learning differences by ensuring they receive the best care and tools for success. Does this sound like you? Read on to...


  • Center Line, United States Binson's Hospital Supplies Inc. Full time

    Job DescriptionJob DescriptionAs an industry-leading health care organization, our mission is to provide our communities with “Better Products, Better Services, Better Lives.” We are a dynamic, growing, family-owned company with locations in Michigan, Indiana and Florida. Join our team at Binson’s Medical Equipment & Supplies today! WHAT WE'RE...


  • Maryland Line, United States Pharmaceutics International Inc Full time

    Job Overview: The QA Associate ensures compliance with cGMP and internal policies, procedures, and specifications. This position is responsible for performing a role in any of the functions: Quality Operations, Process Quality, Batch Release, or Quality Systems in accordance with cGMP and related company SOPs, state, federal and local laws, as applicable. ...


  • Maryland, United States USAJobs Full time

    DutiesThis announcement serves as public notice. Applications submitted will be placed into a pool and will remain on file for selection as positions become available. Vacancies may be filled for up to 6 months after the closing date of this announcement. Applicants may not receive notifications of referral status until the full 6-month eligibility period...