Enrollment Specialist

Summary:

• Primary responsibility is to ensure positive customer interactions with one major product line of the company’s members.
• Interact with members, applicants, providers, and agents via telephone.
• Identify customer concerns and appropriately research and resolve inquiries in a timely manner.
• Continually trained and coached to enhance customer service skills.

Responsibilities:

• Provide accurate and timely answers to benefit, coverage, premium, and claims questions to ensure member satisfaction.
• Assist with coordinating out-of-area or non-affiliated provider referrals for members requiring care outside of the service area.
• Answer Center for Medicare and Medicaid Services (CMS) test calls to ensure compliance with CMS guidelines.
• Assist Federally Facilitated Marketplace (FFM) members in updating financial and subsidy information to ensure compliance with federal guidelines.
• Document interactions with members electronically to maintain accurate member records.
• Utilize electronic systems to verify and assist with wellness benefits inquiries.
• Troubleshoot online portal and secure email issues for members.
• Assist members in filing complaints or grievances using internal and/or federal guidelines.
• Participate in continual coaching to maintain call volume, processing metrics, and accuracy goals.
• Regular attendance required to carry out essential functions.
• Review and meet ongoing competency requirements of the role.

Additional Duties:

• May assist current Medicare Advantage members with plan changes using documented scripts provided by CMS.
• Other duties as assigned.

Requirements:

• Two years’ experience in customer service.
• Demonstrated proficiency with handling high-pressure situations and with verbal and written communication.

Preferred Skills:

• Associate or Bachelor’s Degree in business administration.
• Experience working in a health insurance call center.