The Eligibility Operations Advisor I is responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments. Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing. Main Duties &Responsibilities: - Provide enrollment assistance and HIPP/Premium Assistance program information over the phone to Medicaid eligible recipients and their family members. - Verify, document and investigate the presence of health care coverage for Medicaid recipients and their families. - Assist in the identification of members that may qualify for the HIPP/Premium Assistance program. - Complete periodic reports. - Customer service to include high volume of phone work answering questions and other inquiries regarding the HIPP/Premium Assistance program. - Data entry to include accurate and timely entry of information. - Obtain and/or verify all items related to eligibility and enrollment into the HIPP/Premium Assistance program. - Complete maintenance of active cases during open enrollment and premium review for check processing to assist with maintaining the revenue and program growth. - Required Skills: - Ability to organize well. - Ability to communicate both verbally and in writing, fluently in English. - Ability to provide and represent professionalism in job. - Ability to practice flexibility and adaptability in the workplace. - Ability to work with Microsoft Word and Excel and navigate internet skillfully. - Ability to analyze information and use logic and process to address work-related issues and problems. - Ability to operate with strong interpersonal skills. - Ability to be careful and thorough about detail. - Ability to perform data entry accurately. - Average manual dexterity in use of a PC, phone, 10 key, sorting, filing and other office machines. - Ability to handle conflict appropriately and constructively. - Working knowledge of HIPAA privacy and Security rules. - Ability to perform well in team environment. - Ability to meet deadlines. Required Education& Experience: - High School Diploma or Equivalent Min. 2 year of experience in insurance industry, health care or government sponsored health insurance to include customer service and medical billing knowledge or similar math related experience. Min. 2 year experience working on the phone making inquiries(outbound) and answering calls (inbound). Knowledge of health care terminology is a plus.
Associated topics: agent, commission, client, inside sales, life insurance sales, retail, sales agent, sales position, sales professional, sell