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Membership Representative I / II or III - PS36116

Location: Miami, FL
Job Family: Membership & Enrollment
Req #: PS36116-2467
Date Posted: Jul 12, 2020

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

 

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. 


This position is in the Miami, FL or Denver, CO office locations only and requires availability Monday - Friday 8:00AM- 5:00PM EST/MST for an 8 hour shift.

 

Membership Representative I/II/III

* Manager will determine level based upon the selected applicant’s skill-set relative to the qualifications listed for this position.*

 

Level I: Responsible for enrollment, billing activities and/or maintaining assigned accounts. Must pass the appropriate pre-employment test battery.

 

Primary duties may include, but are not limited to: 

  • May initiate outgoing calls,
  • Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections,
  • Addresses a variety of enrollment questions and/or concerns received by internal request or member request,
  • Ensures accuracy and timeliness of the membership enrollment function, 
  • Responds to inquiries concerning enrollment processes, 
  • Maintains enrollment databases, 
  • May order identification cards or request reports,
  • Determines eligibility and applies contract language for each piece of work assigned, 
  • Screens all incoming requests for complete information needed to process requests.
  • Makes requests for missing information and reaches out to obtain missing information,
  • Accurately and thoroughly documents inquiry outcomes for accurate tracking and analysis,
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner, 
  • Performs basic job functions with help from co-workers, specialists and managers on non-basic issues. 

 

Level II: Responsible for enrollment, billing activities and/or maintaining assigned accounts. Must be able to successfully perform all the duties of the Membership Representative I. 

 

Primary duties may include, but are not limited to: 

  • May initiate outgoing calls,
  • Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections; 
  • Addresses a variety of enrollment questions and/or concerns received by internal request or member request, 
  • Ensures accuracy and timeliness of the membership enrollment function, 
  • Responds to inquiries concerning enrollment processes, 
  • Maintains enrollment databases, 
  • May order identification cards or request reports,
  • Determines eligibility and applies contract language for each piece of work assigned, 
  • Screens all incoming requests for complete information needed to process requests.
  • Makes requests for missing information and reaches out to obtain missing information,
  • Accurately and thoroughly documents inquiry outcomes for accurate tracking and analysis,
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner, 
  • Performs basic job functions with help from co-workers, specialists and managers on non-basic issues. 
  • Thoroughly documents inquiry outcomes for accurate tracking and analysis. 
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

 

Level III: Responsible for enrollment, billing activities and maintaining assigned accounts. Must be able to successfully perform all the duties of the Membership Representative I and II

 

Primary duties may include, but are not limited to: 

  • May initiate outgoing calls,
  • Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections; 
  • Addresses a variety of enrollment questions and/or concerns received by internal request or member request, 
  • Ensures accuracy and timeliness of the membership enrollment function, 
  • Responds to inquiries concerning enrollment processes, 
  • Maintains enrollment databases, 
  • May order identification cards or request reports,
  • Determines eligibility and applies contract language for each piece of work assigned, 
  • Screens all incoming requests for complete information needed to process requests.
  • Makes requests for missing information and reaches out to obtain missing information,
  • Accurately and thoroughly documents inquiry outcomes for accurate tracking and analysis,
  • Thoroughly documents inquiry outcomes for accurate tracking and analysis. 
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner, 
  • Performs basic job functions with help from co-workers, specialists and managers on non-basic issues. 
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
  • Performs error output resolution for electronic eligibility and processes error discrepancy list. 
  • Bills, collects premiums and reconciles payments. 
  • Maintains and reconciles premium bill, self-bill and individual billed accounts. 
  • Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.  
  • Fully proficient in all key areas; performs most complex work.

Qualifications

Requirements

 

Level I

  • Requires High School diploma or GED; 
  • 1 plus years of relevant healthcare customer servicing experience; 
  • Or any combination of education and experience, which would provide an equivalent background.

Level II

  • 1-3 years relevant healthcare customer servicing experience which includes at least 1 year membership experience with the company; 
  • Or any combination of education and experience, which would provide an equivalent background.

Level III

  • 3-5 years relevant membership experience which includes at least 2 years of membership experience with the company;
  • Or any combination of education and experience, which would provide an equivalent background.

 

Preferred Qualifications

  • Membership Enrollment experience.
  • Regulatory environment and government experience
  • Experience working in a production environment with productivity goals. 
  • Working knowledge of Medicare and/or Medicaid terminology and enrollment processes.
  • Strong computer skills.
  • Minimum 35 WPM typing speed.
  • Intermediate Microsoft Excel, Outlook and Word knowledge. 
  • WEM and ISG Experience. 
  • Strong oral and written communications.
  • Strong analytical and problem solving skills.
  • Strong attention to detail and quick decision making skills.
  • Ability to work overtime as needed. 

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


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