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Insurance Enrollment Coordinator

2 months ago

Buffalo, New York, United States Centivo Full time

At Centivo, we are dedicated to supporting the workforce and their employers, who are essential to our economy. Our mission is to provide affordable, high-quality healthcare to those who face challenges in managing their healthcare expenses.

We are currently seeking Enrollment & Eligibility Coordinators to become integral members of our team.

As an Enrollment & Eligibility Coordinator, your primary responsibility will be to oversee the daily management of files, data, updates, and communications related to medical plan enrollment and member eligibility. You will also assess the qualifications necessary for enrollment in the group’s medical plans, which includes verifying coverage regulations, coordinating benefits, and validating medical ID cards.

Key Responsibilities:

Under the supervision of the Enrollment Lead, your duties will include:

  • Assessing systems for eligibility, reinstatement, and termination of healthcare coverage.
  • Conducting weekly audits for assigned clients utilizing member census data to ensure accurate coverage and monitor file feed issues.
  • Identifying the root causes of discrepancies in enrollment data and collaborating with relevant contacts to resolve these issues.
  • Performing client census reviews for auditing and billing purposes.
  • Completing manual enrollment of members into our system when necessary, which includes gathering and entering demographic information and issuing new member IDs.
  • Managing and validating ID card distributions for all groups.
  • Facilitating the loading, transfer, and archiving of daily ID card print files from our claims record system to our print vendor, ensuring that holds are in place and cards are released for printing according to daily schedules.
  • Monitoring and responding to eligibility inquiries and requests from Member Care/CSM and directly from client contacts through various communication channels.
  • Collaborating with Implementation and Account Management teams on matters related to group enrollment and COBRA.
  • Working with external carriers/vendors to ensure accurate reflection of member eligibility.
  • Assisting groups in navigating our employer portal.
  • Coordinating benefits for members.
  • Monitoring and processing claims in the SDS queue.
  • Requesting and reviewing legal documents such as divorce decrees, marriage certificates, and birth certificates to determine dependent eligibility in accordance with plan rules.
  • Identifying potential claims impacts due to eligibility updates.
  • Meeting standard performance metrics and service level agreements established for the Eligibility team.
Qualifications:

Essential Skills and Abilities:
  • Ability to prioritize and organize work effectively to meet deadlines.
  • Capability to navigate multiple systems/programs to investigate issues.
  • Intermediate proficiency in Microsoft Excel.
  • Strong customer service orientation.
  • Excellent verbal and written communication skills.
  • Analytical and problem-solving abilities.
  • Attention to detail.
  • Proven ability to manage multiple assignments competently and efficiently.
  • Strong interpersonal skills, fostering rapport and collaboration with others.
  • Knowledge of benefit plans, policies, and procedures, along with an understanding of medical terminology.
Education and Experience:
  • High school diploma or GED required; an Associate's or Bachelor's degree is preferred.
  • 1-2 years of experience in the healthcare sector is preferred but not mandatory.
Preferred Qualifications:
  • Experience with automated and integrated claim adjudication systems, such as El Dorado-Javelina and/or Health Rules Payer, is advantageous but not essential.
  • Ability to interpret health plan eligibility rules as outlined in the Summary Plan Description (SPD).
  • Knowledge of Coordination of Benefits and Medicare.
  • Experience with the Zelis vendor platform/ID card configuration is a plus.
Work Location:

The ideal candidate will be assigned to a flexible work environment, with options for remote work available for qualified individuals.

Compensation Transparency:
The salary range for this position reflects our anticipated minimum to maximum base salary. Our comprehensive benefits package includes various components that contribute to total compensation, such as bonuses, health benefits (with some employer contributions), paid time off, and equity options.

Our Core Values:
  • Resilience: We understand the challenges of making healthcare affordable, and our mission drives us to persevere through difficulties.
  • Innovation: We are committed to challenging the status quo and building a better healthcare system that serves members, employers, and providers effectively.
  • Positivity: We foster a supportive and energetic environment, celebrating achievements and providing constructive feedback with care.
About Centivo:

Centivo is a pioneering health plan designed for self-funded employers, dedicated to delivering affordable, high-quality healthcare solutions. Our model, centered around primary care-based ACOs, enables employers to achieve significant savings compared to traditional insurance carriers while offering employees substantial benefits. For more information, please visit our website.