Catholic Health Initiatives Temporary Enrollment Representative in FEDERAL WAY, Washington

Temporary Enrollment Representative



Reporting to the Enrollment Supervisor, the Temporary Enrollment Specialist determines eligibility and performs various enrollment and disenrollment processes for Medicare Advantage consistent with CMS Guidance to ensure compliance. The Temporary Enrollment Specialist is expected to perform .efficient and timely processing of enrollment and disenrollment activity within CMS regulatory compliance. This position requires a strong focus on member and client retention through accurate and timely resolution of issues and functions with minimal direction. The Temporary Enrollment Specialist should be able to anticipate workflow needs based on CMS Guidance, established processes, policies and procedures. The Temporary Enrollment Specialist will partner cross-functionally with various operational business units while supporting departmental objectives within company and regulatory guidelines.

Essential Duties and Responsibilities

  • Prepare, process and maintain new and existing member enrollments and or disenrollment’s.

  • Review and process demographic changes, death notifications and power of attorney notifications.

  • Reconciling eligibility discrepancies, analyzing transactional data and submitting retroactive eligibility changes.

  • Interpret and apply the CMS enrollment and eligibility rules and procedures.

  • Maintain a current knowledge of State and Federal regulations.

  • Research and reconcile the errors and rejections received on the weekly and monthly reports (e.g. TRR, RECON report). Determine the appropriate action, make manual corrections if needed and submit corrected transactions.

  • Perform basic clerical functions with proficient PC skills.

  • Research and resolve escalated inquires/issues that are more complex.

  • Perform outbound member calls and miscellaneous projects as necessary.

  • Initiate and assist with developments/changes to increase quality and production.

  • Work cross-functionally with other departments to develop or review processes and to resolve member issues.

  • Act as back-up to the customer service team.

  • Other duties as assigned.


Education and Experience

  • High School or equivalent experience required

  • Healthcare experience required

  • Medicare or Medicare Advantage experience preferred

  • 2 years of Enrollment Department experience preferred

  • CMS reporting knowledge preferred

Certificates, Licenses and Registrations

  • None required

Job Administrative and Clerical


Daily Schedule Days

Scheduled Hours per 2-week Pay Period 80

Weekends Required None

Req ID: 2017-R0120597