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Job Responsibilities:

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 is available to support special projects
Assist in maintaining the integrity of eligibility tasks.
External phone call with other health insurance to determine primary payer.
Prioritizes daily, weekly, and monthly job tasks to support regulatory requirements and service level agreements.
Displays imitative to complete assigned tasks timely and accurately and balances workload to assist peers and 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.

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