This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Address and reconcile enrollment reports and eligibility concerns in accordance with policy, procedure, and state coverage guidelines.

• Initiate outreach and provide materials for newly enrolled health plan members, their dependents, and employer groups.

• Interpret and enforce rules and regulations as outlined in contractual agreements with employer groups and vendors.

• Conduct membership data extraction reports for employer group audits and ensure compliance with performance risk guarantee commitments.

• Update, authorize, and interpret membership data and workflows within employer group online software modules.

• Assess member eligibility and manage terminations and disenrollments.

• Prepare, create, and send enrollment-related correspondence to subscribers and members.

• Evaluate whether services fall under covered benefits based on the line of business and product design.

• Examine suspended claims and resolve them in accordance with relevant policies, procedures, and product benefits.

• Offer team-building resources and guide colleagues to the appropriate claims resolution policies and procedures.

• Provide daily assistance and advice to member and provider services staff concerning claims matters.

• Investigate claim issues from participating providers and establish criteria for payment reconsideration.

• Address customer concerns, deliver education and guidance, and uphold customer satisfaction.

• Engage in cross-training and enhance processes within the Customer Service team.

⛳️ Requirements

• High School Diploma or Equivalent (GED) (Required)

• At least 1 year of customer service experience (Required)

• Strong communication skills

• Skills in customer retention

• Proficient customer service skills

• Must reside in the Eastern Standard Time Zone

• Capability to work 40 scheduled hours each week

• Must adhere to organizational policies and procedures

🏝️ Benefits

• Healthcare benefits available for both full-time and part-time positions from day one

• Vision coverage

• Dental coverage

• Benefits for domestic partners

• A collaborative, cooperative, and collegial work environment