Membership Representative II - Alignment Healthcare

The Membership Representative II performs daily operations regarding member disenrollments, retro processing, reinstatements and Out of Area (OOA). Ensures members are properly process within Centers of Medicare and Medicaid (CMS), the third party vendors and EZ-Member.

Essential Duties and Responsibilities
Essential duties and responsibilities include but are not limited to:

• Processes all disenrollments from the Weekly TRR and Monthly. Ensures we have the correct documentation in EZ-Member.
• Ensure all correspondence is mailed to members on a timely manner.
• Reviews on a weekly basis the Weekly TRR. Follows up with any pending enrollments or rejections. 
• Submits in a timely manner to the 3rd party vendor any retro disenrollments, cancellation, retro enrollments, reinstatements and OOA’s. Ensures they are processed correctly.
• Monitors all submission to 3rd party vendor ensures all submissions are processes within the correct time frame.
• Submits monthly reports to the Membership Director of Monthly submissions to 3rd party vendor including OOA, Retro Enrollments, Retro Disenrollments and Reinstatements 
• Ensures all members outside of the service area are processed on a timely manner and ensure the letters are mailed with in CMS guidelines in order to be compliant. 
• Act as liaison representative to the Sales Representatives. Provide any issues identified to the necessary internal department heads.
• Assist in the departmental compliance tasks which include the Mailing, Annual Notification of Coverage Letter and any other necessary compliance mailing.
• Performs other duties as assigned. 

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Education and/or Experience:  High school diploma or general education degree (GED); or one to three years related experience and/or training; or equivalent combination of education and experience.
• Certificates, Licenses, Registrations:  None required.
• Other Qualifications:  
• Knowledge of Medicare Managed Care Plans.
• Two to three years customer service experience.
• Direct sales or related experience preferably in the Managed Care industry.
• Bi-lingual (English/Spanish) required.
• Must be familiar with CMS MMR and TRR files

Skills and Abilities

• Language Skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.
• Mathematical Skills:  Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills:  Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
• Computer Skills:  Strong computer skills.
• Other Skills and Abilities:
• Strong organizational skills.
• Good telecommunications skills.
• Good organizational skills.

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
• The employee is frequently required to walk; stand; reach with hands and arms.
• The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
• The employee must occasionally lift and/or move up to 20 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Working Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay Range: $22-$24 hourly