Medical- Open Enrollment Specialist

Data Entry-Open Enrollment

• Job Summary:
• Responsible for maintaining accurate and up-to-date member coverage information in a health insurance setting.
• Ensuring data integrity and accuracy of member records from an enrollment perspective.

Essential Functions and Responsibilities:

• Reviewing and reconciling member records: This includes reviewing eligibility dates, plans, primary care provider (PCP) information, and other relevant details.
• Comparing and reconciling enrollment information: Comparing enrollment information to relevant files, such as 834 files, and making necessary adjustments to ensure correct data is present.
• Enrolling new or reinstated members: Processing requests to enroll new members or reinstate existing ones.
• Reviewing and reconciling Third Party Liability (TPL) records: Examining and reconciling records related to third-party liability.
• Following procedures and standards: Adhering to team procedures, including HIPAA policies and procedures, and meeting established performance standards for quality, turnaround time, and productivity.
• Maintaining internal customer relations: Interacting with staff to address enrollment issues, conducting research, and ensuring accurate and complete enrollment record information.
• Contacting members or other involved parties: Reaching out to insured individuals or other parties to obtain additional or missing information.
• Maintaining detailed records: Keeping accurate records of all member interactions.

Qualifications:

• Education: High School Diploma or GED.
• Experience: Prior experience in enrollment processing, particularly with Medicaid, Medicare, or Commercial enrollment. Experience with specific systems, such as Facets is preferred.
• Technical Competencies:
• Ability to work remotely and independently.
• Strong attention to detail.
• Strong interpersonal, time management, and organizational skills.
• Good oral/written communication and analytical skills.
• Ability to work in a fast-paced environment and navigate multiple systems, often using dual monitors.

About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies. Job Title: Data Entry Location: Remote work from home Job Type: Full Time Schedule: Monday through Friday 8:00am-4:30pm CST FLSA Status: Non-Exempt/Hourly Grade: H Function/Department: Health Plan and Healthcare Services Reporting to: Team Lead - Operations Pay Range: $14.00 an hour Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law. Firstsource also takes Affirmative Action to ensure that minority group individuals, females, protected veterans, and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities. Apply To this Job Apply for this job