Why Choose Jefferson Health Plans?
We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.
We are seeking a talented and enthusiastic Enrollment Intake Specialist to join our team!
Working under general supervision The Enrollment Representative is responsible for updating eligibility systems with enrollment and membership-related data and performing transactions that result in member enrollment communications as well as notices to State and Federal regulatory agencies. In addition, the incumbent must process transactions to comply with highly regulated eligibility and enrollment procedures. The position is also responsible for explaining eligibility rules and policies of programs to all applicants.
As the Enrollment Intake Specialist, your daily duties may include:

• Research and correct eligibility discrepancies identified through error reports
• Update member demographic and eligibility information on the membership eligibility system in response to requests from other business areas
• Reconcile member eligibility data to ensure internal systems match State and Federal information
• Validate eligibility requirements associated with new enrollments, disenrollments, demographic changes, and benefit package changes
• Communicate enrollment discrepancies to State and Federal agencies or their designates
• Resolves outbound and inbound calls to applicants and members
• Review and analyze incomplete applications to identify additional information required to complete the enrollment process
• Coordinate and process Primary Care Physician selections for new members

Qualifications

• High School Diploma or equivalency required.
• 1-2 years of experience in managed care or healthcare insurance is recommended.

Skills, We Value:

• Ability to maintain strict confidentiality of applicant information in the performance of job functions.
• Demonstrated ability to organize work efficiently, evaluate and establish priorities, to handle multiple projects simultaneously.
• Demonstrated ability to receive direction, exercise judgment, and make appropriate decisions in handling confidential and time-sensitive documents and information.
• Able to present oneself professionally when dealing with public contacts and internal staff.
• Able to express oneself clearly and concisely, both verbally and in writing.
• Proven experience with Microsoft Office products
• Experience in Medicaid, Medicare, and CHIP eligibility process is highly beneficial.