- 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.
- Lead a group of “New Hires” for training purposes.
- Correspond with Tier manager to ensure call flow.
- Gather clients information via telephone over a recorded line.
- Enroll clients into HMO, PPO, and Medicare Advantage health plans.
- 2nd place in Top 3 Enrollment Specialist out of a group of 25