Member Enrollment Representative I

Job Description

Member Enrollment Representative I remote type Remote locations Somerville-MA time type Full time Job Summary Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. As part of the Member Enrollment Team, you will be responsible for the enrollment tasks primarily for the Medicaid line of business, which includes the entry of information into MGBHP’s enrollment system and working with reports to resolve discrepancy issues. As business need requires, you will provide back up support for other lines of business, such as commercial. As an enrollment representative, you will have many interactions with internal and external clients as well as group administrators, therefore excellent customer service skills are essential. Other duties include, assisting with monthly reconciliation, assisting on special projects as needed, and researching discrepancy reports. In addition, you will also help with other general administrative duties and special projects as assigned. The ideal candidate has experience with member enrollment for Medicaid members in QNXT. Essential Functions • Dealing with complex enrollment issues from either internal representatives, external vendors, or sales and account executive staff. These issues include but are not limited to eligibility, pharmacy, billing and group set up • Provide back up support for daily operations in team member’s absence • Responsible for navigating various systems (QNXT, Revs, GIC Magic, etc) to resolve member issues • Responsible for understanding the distinction between different lines of business (Medicaid, Commercial, C-Chip, C-Choice, etc.) • Meet or exceed daily productivity goals • Meet or exceed monthly QC goal • Responsible for reviewing daily error reports. • Participating and engaging in all team meetings • Attend meetings/represent the department on projects as needed • Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships within the organization • Hold self and others accountable to meet commitments • Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise • Other duties as assigned with or without accommodation Qualifications Education High School Diploma or Equivalent required and Associate’s Degree Healthcare Administration or the equivalent combination of training and experience preferred Experience At least 1-2 years of experience in a customer service, administrative, or enrollment role required Member enrollment experience highly preferred QNXT experience highly preferred Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value Bring fresh ideas forward by listening to and working with employees and the people we serve Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner Strong, demonstrated track record of an ability to execute on time Strong aptitude for technology-based solutions Ability to inject energy, when and where it’s needed Current in healthcare trends Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be” Ability to develop, introduce, defend, and gain support for a new ideas and approaches Ability to translate and communicate complex topics in a variety of forums Strong verbal, active listening, and written communication skills required Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy Excellent interpersonal skills, including the ability to influence others at all levels of an organization Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback Unquestionable integrity Additional Job Details (if applicable) Working Conditions This is a remote role that can be done in most US states This is a Monday through Friday role and the schedule will likely be 8 AM – 4:30 PM ET Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $19.42 – $27.74/Hourly Grade 3 remote type Remote locations Somerville-MA time type Full time Job Summary Job Summary Job Summary Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. As part of the Member Enrollment Team, you will be responsible for the enrollment tasks primarily for the Medicaid line of business, which includes the entry of information into MGBHP’s enrollment system and working with reports to resolve discrepancy issues. As business need requires, you will provide back up support for other lines of business, such as commercial. As an enrollment representative, you will have many interactions with internal and external clients as well as group administrators, therefore excellent customer service skills are essential. Other duties include, assisting with monthly reconciliation, assisting on special projects as needed, and researching discrepancy reports. In addition, you will also help with other general administrative duties and special projects as assigned. The ideal candidate has experience with member enrollment for Medicaid members in QNXT. Essential Functions • Dealing with complex enrollment issues from either internal representatives, external vendors, or sales and account executive staff. These issues include but are not limited to eligibility, pharmacy, billing and group set up • Provide back up support for daily operations in team member’s absence • Responsible for navigating various systems (QNXT, Revs, GIC Magic, etc) to resolve member issues • Responsible for understanding the distinction between different lines of business (Medicaid, Commercial, C-Chip, C-Choice, etc.) • Meet or exceed daily productivity goals • Meet or exceed monthly QC goal • Responsible for reviewing daily error reports. • Participating and engaging in all team meetings • Attend meetings/represent the department on projects as needed • Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships within the organization • Hold self and others accountable to meet commitments • Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise • Other duties as assigned with or without accommodation Qualifications Qualifications Qualifications Education Education High School Diploma or Equivalent required and Associate’s Degree Healthcare Administration or the equivalent combination of training and experience preferred High School Diploma or Equivalent required and Associate’s Degree Healthcare Administration or the equivalent combination of training and experience preferred Experience Experience At least 1-2 years of experience in a customer service, administrative, or enrollment role required Member enrollment experience highly preferred QNXT experience highly preferred At least 1-2 years of experience in a customer service, administrative, or enrollment role required Member enrollment experience highly preferred QNXT experience highly preferred Knowledge, Skills, and Abilities Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value Bring fresh ideas forward by listening to and working with employees and the people we serve Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner Strong, demonstrated track record of an ability to execute on time Strong aptitude for technology-based solutions Ability to inject energy, when and where it’s needed Current in healthcare trends Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be” Ability to develop, introduce, defend, and gain support for a new ideas and approaches Ability to translate and communicate complex topics in a variety of forums Strong verbal, active listening, and written communication skills required Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy Excellent interpersonal skills, including the ability to influence others at all levels of an organization Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback Unquestionable integrity Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value Bring fresh ideas forward by listening to and working with employees and the people we serve Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner Strong, demonstrated track record of an ability to execute on time Strong aptitude for technology-based solutions Ability to inject energy, when and where it’s needed Current in healthcare trends Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be” Ability to develop, introduce, defend, and gain support for a new ideas and approaches Ability to translate and communicate complex topics in a variety of forums Strong verbal, active listening, and written communication skills required Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy Excellent interpersonal skills, including the ability to influence others at all levels of an organization Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback Unquestionable integrity Additional Job Details (if applicable) Additional Job Details (if applicable) Additional Job Details (if applicable) Working Conditions Working Conditions This is a remote role that can be done in most US states This is a Monday through Friday role and the schedule will likely be 8 AM – 4:30 PM ET This is a remote role that can be done in most US states This is a Monday through Friday role and the schedule will likely be 8 AM – 4:30 PM ET Remote Type Remote Type Remote Type Remote Work Location Work Location Work Location 399 Revolution Drive Scheduled Weekly Hours Scheduled Weekly Hours Scheduled Weekly Hours 40 Employee Type Employee Type Employee Type Regular Work Shift Work Shift Work Shift Day (United States of America) Pay Range Pay Range Pay Range $19.42 – $27.74/Hourly Grade Grade Grade 3