Member Enrollment Representative

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Member Enrollment Representative performs a variety of specific functions associated with enrollment to facilitate accurate enrollment data for all products.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities:

• Research and resolve daily materials error report issues.
• Accurately process PCP Routing Queue (requests from Customer Care to update PCPs) daily.
• Process Claims Routing Queue to ensure claims can be re-processed with no issues.
• Using the PCP Selection Form, update Member’s PCP and demographics.
• Work PCP Error Report by correcting error in PCP Assignments (gaps in coverage, inappropriate assignments, etc.).
• Responsible for conducting all processes associated with enrolling newborns into the Plan, including Newborn Temporary Record Creation, Eligibility and Faxing).
• Research Casehead information from 834 data and MassHealth Virtual Gateway to update member’s casehead as appropriate.
• Performs other duties as assigned.

Qualifications:

Education:

• Associate degree or equivalent combination of education, training, and work experience is required.

Experience:

• 1 or more years experience in an administrative, clerical position within the insurance, financial or health care industry is required.
• Additional post-secondary education may be substituted for work experience.
• 1 year Operations experience in a managed care or healthcare environment is preferred.

Competencies, Skills, and Attributes:

• Excellent customer service skills are required.
• Detail oriented with a commitment to accuracy.
• A strong working knowledge of Microsoft Office products.
• Ability to work with a team as well as independently.

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Ability to work overtime in peak periods.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees