enrollment specialist Resume Examples

enrollment specialist

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Received inbound & Outbound calls and directed them to the appropriate departments.
Assisted prospective and current members with choosing Medicare health plans.
Reviewed plan information with the current and prospective members.
Maintained communication with member services departments and supervisors.
Assisted with health assessments and entered new customer’s profiles into the database.

Assist customers in understanding their options, enrolling in health plans, and determining eligibility for Subsidies and tax credits
Using Meds software and IQS software determine which managed care program the beneficiary can choose from.
Handles telephone communication and written correspondence with providers, and fiscal intermediaries in an efficient and effective manner that facilitates the Provider Enrollment process.
Correct applications to verify enrollment, Make adjustments to Insurance plans, Assist with Manged care, Physicians or Dentist.
Communicate with third party insurance agencies to manage Enrollment, Specialize in Polices, Adhere to a Call Queue, Assist with locating Primary care physicians, Hospitals, and or Behavioral

Over sees their preparation, processing and maintenance of new members and re-enrollees.
Assigning PCP’s to qualifying members.
Enter, update, and review data to ensure correct data are available by utilizing the State’s Rosters.
Understand, explain, and document Medicare and Medicaid needs to employees and members.
Seek information where gaps of coverage are identified.