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Healthcare Enrollment Services Representative II
2 months ago
The Customer Solution Center Enrollment Services Representative II is a key member of our team at L.A. Care Health Plan, responsible for ensuring the accuracy and integrity of member data in our core system. This role involves auditing, researching, and updating member information, as well as troubleshooting complex issues related to member coverage and access to care.
Key Responsibilities- Audit inbound eligibility file load errors, intake forms, and email requests related to member coverage, provider, and plan partner assignments.
- Make recommendations or updates to member information and other related transactions as needed, within the timeframe outlined in company policies and procedures.
- Collaborate with internal and external departments to ensure timely resolution of member issues and access to care.
- Assist with user acceptance testing (UAT) related to system and/or process defects and issues.
- Provide support and ownership of escalated and/or complex issues related to member coverage, preventing member access to care.
- High School Diploma or High School Equivalency Certificate.
- 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, as well as other related government-funded/sponsored healthcare programs.
- 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.
- Previous experience in Managed Health, preferably in Customer Service, Enrollment Services, or Claims.
- Knowledge in MARx and AEVS.
- Knowledge in 834, TRR, HCO, or RTZ member eligibility electronic files.
- Bilingual in one of L.A. Care Health Plan's threshold languages (English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese).
