Responsibilities
- Process enrollment and disenrollment actions accurately and on schedule, following Medicare, Medicaid, and internal compliance guidelines.
- Handle daily intake and system entry of enrollment and disenrollment applications from multiple sources for CMS submission.
- Support daily review and processing of the Daily Transaction Reply Report (DTRR) to ensure data integrity.
- Help monitor and manage CMS OEC, Auto, and Facilitated web-based transaction files.
- Investigate and respond to inquiries from internal and external customers.
- Create and send correspondence in response to member requests as needed.
- Conduct root cause assessments for member concerns and system-related issues.
- Enter coordination of benefits (COB) data correctly to support timely claims processing.
- Support the mailroom in handling and processing returned mail.
- Meet established benchmarks for productivity, accuracy, and regulatory compliance.
- Recognize recurring issues and suggest process improvements.
