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About the Role

Under the direction of Assigned Management, the Enrollment Specialist performs enrollment core processing and servicing in accordance with Health Plan Operation’s enrollment regulations, Underwriting Guidelines, and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member, and group administrator inquiries for all product lines. The B version of this role requires regular phone engagement.

Responsibilities

Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations.
Maintain communication with Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, Customer Care, and external Customers, groups, or Brokers.
Responsible for the enrollment of new groups, renewals, new member enrollment, and member movement.
Prepare, process, and maintain member enrollments using multiple Health Plan enrollment systems.
Install and maintain member information, new enrollment, benefit changes/renewals, cancellations, and reinstatements.
Review and assess member enrollment activity and associated documents for accuracy based on processing regulations/guidelines.
Research, interpret, and respond to inquiries from internal and external customers, business partners, brokers, consultants, and groups regarding products, services, and policies.
Run pre-built reports.
Review, validate, and update transaction errors from electronic and paper sources impacting eligibility interfaces.
Identify issues and respond to all work items within department service level agreements (SLAs).
Prioritize aged and Performance Guarantee Transactions and take necessary action to complete them on time.
Maintain knowledge and accuracy in entry-level processing within a minimum of 3 inventory areas.
Attend training to support job role/function and share knowledge with the team.
Attend and participate in meetings and share information with the team.
Execute quality service by meeting productivity and accuracy metrics, compliance and member touchpoint measures (MTM) targets, and CMS processing timeframes.
Gain a general understanding of the cross-functional enrollment process and operating systems.
Demonstrate high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
Maintain high regard for member privacy in accordance with corporate privacy policies and procedures.
Perform other functions as assigned by management.
Prepare, process, and maintain group enrollment using multiple Health Plan enrollment systems.
Install and maintain group information including new group setup, benefit changes/renewals, cancellations, and reinstatements.
Review and assess enrollment activity and associated documents for accuracy using knowledge and expertise of processing regulations/guidelines.
Handle Designated Record Set (DRS) requests and may serve as a point person for the Account Service team.
Adjust or triage for adjustment, as situation requires, enrollment for subscriber additions, deletions, and changes, and initiate correspondence requesting additional information or verification.
Act as a resource to support and/or cross-train other team members.
Responsible for knowledge and accuracy in at least half of inventory areas.
Gain in-depth understanding and working knowledge of the cross-functional enrollment process and operating systems.
Identify issues, patterns, and/or trends affecting compliance, customer satisfaction, and system performance, and independently recommend and initiate changes and improvements.
Assist in creating and/or updating operating manuals and/or Desk Level Procedures (DLPs).
Staff Enrollment phone lines to resolve inbound telephone inquiries promptly and accurately.
Demonstrate proficiency in most inventory areas and operating systems with expertise in specific job functions.
Mentor and collaborate with others on the team in utilizing tools, sharing best practices, and serving as a role model.
Serve as a subject matter expert for the department.
Cross-train on any task, demonstrating comprehension and retention of new skills.
Continuously work towards identifying and removing barriers to increased productivity, quality, cost-effectiveness, timeliness of operations, and customer satisfaction.
Process enrollment activities for complex accounts.
Adjust daily assignments to prioritize urgent or complex cases.
Research, respond, and resolve eligibility inquiries working directly with internal and external customers via multiple communication methods.
Assist with system releases and production validation.
Create test cases, test processes and documents, and establish procedures for the implementation of new products and work efforts.
Participate in end-user testing.
Research complex cases to identify root cause, recommend, and execute resolution.
Handle complex and/or sensitive cases, including processing for key brokers, accounts, special arrangements, government programs, and enrollment resolution cases requiring deep research.
Serve as department representative on corporate projects and cross-functional work groups, acting as a subject matter expert.
Provide advice and counsel to project teams and leadership on the implications of requirements on productivity and quality.

Requirements

Completed High School Diploma or Equivalent.
Minimum of two (2) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position, preferred (Level I).
Minimum of three (3) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position, preferred (Level II).
Minimum of four (4) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position, preferred (Level III).
Minimum of five (5) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position, preferred (Level IV).
Rating of “Performing” or above for minimally 12 months (Levels II, III, IV).
Solid written and verbal communication skills (Level I).
Proven organizational, analytical, and time management skills (Level I).
Basic Computer proficiency, including experience in Microsoft Office Suite (Level I).
Attention to detail and accuracy (Level I).
Ability to multi-task to efficiently resolve customer concerns.
Ability to actively listen to customer while simultaneously taking notes (B Version).
Ability to be on the phone regularly (B Version).
Organizational, reasoning, and problem-solving skills (Level II).
Takes accountability and ownership of issues and resolution with minimal supervision (Level II).
Demonstrates global thinking and takes initiative to recognize opportunities within the team (Level II).
Strong written and verbal communication skills (Level III).
Strong Computer proficiency, including experience in Microsoft Office Suite (Excel) (Level III).
Provide mentoring and support to new hires and peer group (Level III).
Assist with tasks assigned by management that require advanced problem-solving skills (Level III).
Self-sufficient in ability to efficiently resolve complex & escalated issues (Level IV).
Lead tasks assigned by management that require advanced problem-solving skills across multiple areas (Level IV).
Ability to complete work in a traditional office environment under fluorescent lighting.
Ability to arrive on time at work and as scheduled.
Ability to meet minimum performance metrics.
Ability to orally communicate.
Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time.
Must be able to travel across the enterprise.
Ability to work in a home office for continuous periods of time for business continuity.

Skills

Enrollment processing
Servicing inquiries
HIPAA regulations
Health Plan Operation’s enrollment regulations
Underwriting Guidelines
Government regulations
Broker, member, and group administrator inquiry servicing
Telephone communication
Email communication
Written inquiry response
Lobby walk-in customer service
On-site visits
Multi-product line knowledge
Government Programs enrollment
Small, Mid, and Large Employer Group Subscriber Enrollment
Interdepartmental communication
External customer communication
Broker communication
Group communication
New group enrollment
Renewal processing
New member enrollment
Member movement processing
Health Plan enrollment systems utilization
Member information installation and maintenance
Benefit changes processing
Renewal processing
Cancellations processing
Reinstatements processing
Sales systems utilization
Marketplace systems utilization
Enrollment systems utilization
Document accuracy review
Regulatory knowledge
Guideline interpretation
Report generation
Transaction error review and validation
Eligibility interface management
Issue identification and resolution
Service Level Agreement (SLA) adherence
Performance Guarantee Transaction prioritization
Metric adherence
Inventory area processing
Training participation and knowledge sharing
Meeting participation and information sharing
Productivity metric achievement
Accuracy metric achievement
Compliance adherence
Member Touchpoint Measure (MTM) target achievement
CMS processing timeframe adherence
Cross-functional enrollment process understanding
Operating systems understanding
Integrity
Mission and values support
Corporate Code of Conduct adherence
Lifetime Way values and beliefs adherence
Member privacy maintenance
Group enrollment processing
New group setup
Designated Record Set (DRS) handling
Account Service team support
Enrollment adjustment and triage
Correspondence initiation
Cross-training
Global thinking
Initiative
Process review and improvement recommendation
Operating manual creation/updating
Desk Level Procedure (DLP) creation/updating
Inbound telephone inquiry resolution
Mentoring
Collaboration
Best practice sharing
Role modeling
Subject matter expertise
Complex account enrollment processing
Urgent/complex case prioritization
Eligibility inquiry resolution
System release participation
Production validation
Test case creation
Process testing
Document testing
New product implementation procedures
Root cause analysis
Complex case resolution
Sensitive case handling
Key broker processing
Special arrangements processing
Government programs processing
Enrollment resolution case processing
Corporate project representation
Cross-functional work group representation
Advice and counsel provision

Location

Remote work opportunity (case-by-case basis)

Work Type

Full-time

Experience Level

Entry Level (Level I)
Intermediate (Level II)
Advanced (Level III)
Expert (Level IV)

Education Level

High School Diploma or Equivalent

Salary/Compensations

Level I: $20.00 - $24.43
Level II: $20.40 - $27.00
Level III: $20.80 - $30.80
Level IV: $21.20 - $33.03

Benefits

Participation in group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays

About the Company

The Lifetime Healthcare Companies

Equal Opportunity

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.