The Sr Rep, Enrollment handles all processes related to membership eligibility inquiries and ensures membership accuracy within the system. Represents Enrollment Operations as a subject matter expert (SME) and works collaboratively with external clients and internal partners to resolve membership issues. Utilizes multiple applications and has deep understanding of eligibility related processes.
• Completes operational processes to resolve eligibility issues including but not limited to incoming/outgoing eligibility, primary care provider (PCP) assignment, and ID card processing.
• Verifies other health insurance to establish primary and secondary payors in the system.
• Reconciles eligibility information with State or Federal Agencies using varied methods.
• Analyzes complex eligibility issues and provides resolution to internal partners and external clients.
• Responds, documents and tracks all proceedings with State and/or Federal Agencies.
• Utilize critical thinking skills to proactively communicate eligibility issue trends with Management.
• Manages high volumes of tasks to support regulatory requirements and service level agreements and competing priorities.
• Contributes to technical system enhancements by performing user testing.
• Participate as a team player by assisting peers and Management to support department goals.
• Trains new staff on assignments.
Associate degree or equivalent combination of education and experiences
1-3 years related work experience
Intermediate Microsoft Excel and Microsoft Word
Bachelor's Degree or equivalent combination of education and experiences
3-5 years related work experience
Basic knowledge ANSI X12 834
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Apply on company website