• Lead Enrollment Unit Representative

    Job Locations US-CA-Fairfield
    Job ID
    2018-1348
    Category
    Other
  • Overview

    In addition to the Enrollment Specialist duties, the Enrollment Unit Lead (EUL) provides assistance to team members as well as the Enrollment Unit Supervisor. The EUL provides subject matter expertise and serves as an escalation point for Enrollment Specialists, assisting with complex member and provider issues as they occur. 

    Responsibilities

    • Responds to member and provider calls in a courteous and professional manner, answering questions and inquiries regarding membership, eligibility, benefits, claims, policies and procedures. Completes forms and other paperwork
    • Educates members and providers on the guidelines and policies of PHC
    • Assesses and resolves problems within scope of authority; escalates unusual questions or problems to higher authority levels
    • Assists with development of training agendas and materials, provides training and guidance to Enrollment staff
    • Assists with the development of processes and operational memos and policies
    • Conducts monthly audits and call monitoring for Enrollment Specialists as determined by management
    • Call monitoring outbound and inbound calls to ensure completeness of work from Enrollment Specialist
    • Handles escalated calls or “Supervisor” calls
    • Assists walk-in members
    • Participates in special projects, tasks, and assignments as needed
    • Handles complex and lengthy issues that cannot be resolved by the Enrollment Specialist
    • Attends and delivers community presentations, orientations, and member intake presentations as needed
    • Processes enrollment data and provider changes
    • Assists with any member mailing notifications
    • Provides guidance and support in testing new systems and processes
    • Maintains a staff rotation schedule
    • Complete trainings as assigned
    • Models strong work habits and excellent customer service
    • Other duties as assigned

    Qualifications

    Education and Experience

    High School Diploma or equivalent; minimum three (3) years’ experience in a managed care customer service environment preferred.

     

     

    Special Skills, Licenses and Certifications

    Thorough knowledge of managed care and Member Services

    Policies and Enrollment Unit procedures preferred. Excellent understanding of all PHC policies and procedures relating to all aspects of care. Excellent understanding of external agencies that provide services to PHC members. Strong understanding about the Medi-Cal eligibility process. Working knowledge of business software applications. Proficient use of computer keyboard to access data. Bilingual skills in Spanish, Tagalog, or Russian are preferred. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

     

     

    Performance Based Competencies

    Must have the following skill sets:

    ·        Strong oral and written communication 

    ·        Excellent Customer Service

    ·        Exceptional Organization skills

    ·        Solid Judgment and Analytical abilities

     

    Other required competencies and abilities

    ·        Prioritize issues

    ·        Handle sensitive issues with tack and diplomacy

     

    Work Environment And Physical Demands

    Ability to use a computer keyboard. More than 80% of work time is spent

    talking on the telephone and using a computer monitor. When required,

    ability to move, carry, or lift objects of varying sizes, weighing up to 25 lbs.

     

     

     

     

    Additional Preferred Skills: Must be strong in the following skill sets; communication, (written and oral), multi-tasking, time management, organization, strong problem solving and auditing skills. Good working knowledge of Word, Excel & Outlook. Able to type 35 wpm and 10-key. 

     

     

     

    All HealthPlan employees are expected to:

     

    • Provide the highest possible level of service to clients;
    • Promote teamwork and cooperative effort among employees;
    • Maintain safe practices; and
    • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

     

    IMPORTANT DISCLAIMER NOTICE

     

    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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