Process Associate
- Performs processes to resolve the following eligibility exceptions within the required State/Regulatory timeframes: enrollment file errors, ID card generation errors, PCP assignments, and 834 enrollment files to vendor/third-party administrators.
- Process COB eligibility through proper application to ensure accurate information is represented in the company enrollment system
- Assists with the support of the newborn enrollment functions, including call center, claims, and encounter requests for verification and updates, PCP assignment activity, enrollment record error reports, enrollment/disenrollment activity, and Mass Member Moves.
- As needed, available to support special projects
- Assist in maintaining the integrity of eligibility tasks.
- External phone call with other health insurance to determine the primary payer.
- Prioritizes daily, weekly, and monthly job tasks to support regulatory requirements and service level agreements.
- Displays initiative to complete assigned tasks timely and accurately, and balances workload to assist peers and the Supervisor.
- Provides knowledgeable response to internal and external inquiries regarding eligibility, ID cards, selection of primary care provider, and state enrollment transactions.
- Reconciles eligibility with State Agencies using varied methods. Tracks and documents all transactions with State Agencies.
- High School Diploma or GED Equivalent
- 0-6 months of experience in the job description
- Excellent interpersonal and communication skills to deal effectively with all necessary levels within and outside the organization.
- Demonstrates analytical and innovative excellence for current state and future state challenges at both the strategic and tactical level.
- Strong organizational skills and superior attention to detail. Strong decision maker.
- Ability to review documents for accuracy, completeness, and compliance; compile data and information for reports; compose letters and memoranda.
- Ability to gather and research data (i.e., statutes, regulations, articles).
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