The Role
Provides telephonic customer service to health plan members, researches enrollment and billing inquiries, processes applications and plan changes, verifies records, reconciles beneficiary data across government systems, fulfills member materials, and documents outcomes. The role requires compassionate communication, healthcare terminology knowledge, problem-solving skills, and bilingual English/Spanish fluency.
Summary Generated by Built In
Job Summary & Responsibilities
Preferred Qualifications
As an Enrollment Representative, you will play a key role in assisting callers by researching complex health-related inquiries, status updates, and potential plan options. You will be responsible for enrollment and billing activities, maintaining assigned accounts, and navigating multiple databases to ensure accurate and efficient service. The ideal candidate is comfortable working across various systems and can confidently and compassionately engage with callers while delivering a positive experience.
Preferred Qualifications
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Provides customer service to plan members via telephonic communication.
- Responds to incoming calls, initiates outgoing calls answering enrollment related questions, resolving issues and educating callers.
- Verifies enrollment status, updates patient records.
- Addresses a variety of enrolment questions or concerns.
- Processes enrollment applications and plan change requests
- Reconciles beneficiary information housed in Plan membership system with a variety of government system and reports, including but not limited to Marx, FLMMIS, MMR, DTRR, LEP, Detail, etc.
- Processes return mail (inclining scanning) and assist with researching invalid address information.
- Fulfills member material, including beneficiary forms.
- Screens all forms and data for all paperwork received from Sales.
- Thoroughly documents inquiry outcomes for accurate tracking and analysis.
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
QUALIFICATIONS
- Familiarity with medical terminology, health plan documents, or benefit plan design
- Experience working with vulnerable populaitons
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner, consistently meeting commitments)
- Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
- Proficient problem solving approach to quickly assess current state and formulate recommendations
- Proficient in translating healthcare-related jargon and complex processes into simple, step-bystep instructions customers can understand and act upon
- Flexibility to customize approach to meet all types of member communication styles and Personalities
- Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 8:00pm EST
WORK EXPERIENCE
Minimum of one (1) year of sales, account management or customer service experience (preferabley in a Health Management Organization).
LANGUAGE SKILLS
Bilingual English/Spanish fluency.
Skills Required
- Minimum of one year of sales, account management, or customer service experience, preferably in a health maintenance organization
- Bilingual English and Spanish fluency
- Familiarity with medical terminology, health plan documents, or benefit plan design
- Experience working with vulnerable populations
- Ability to build rapport and communicate compassionately with customers
- Ability to listen effectively, collect relevant information, and identify member needs
- Proficient problem-solving skills
- Ability to explain healthcare terminology and complex processes clearly
- Ability to adapt communication style to different member personalities
- Availability to work any eight-hour shift between 8:00 a.m. and 8:00 p.m. EST
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
Medicare Advantage Plan Founded and led by the LEON family, with the commitment of improving the lives and health of all members.
