Membership Representative at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

MEMBERSHIP REPRESENTATIVE

Summary

The Membership Representative is responsible for all new plan enrollments. Researching validating and reconciling enrollments from the error reports and CMS (Center for Medicare and Medicaid Services) daily files. Ensures all data entry is completed with the require time frame.

Essential duties and responsibilities may include but are not limited to:

1. Sending correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections.


2. Ensure the TRR is reviewed on a daily basis.


3. Submit daily transaction files to CMS.


4. Ensure that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).


5. All OEV letters are to be logged in the membership data base.


6. Act as a liaison to the Sales Representatives. Ensure that new enrollments are processed properly.  Provide any issues identified to the necessary internal department heads.


7. Data entry of all enrollment applications as well as disenrollments into plan’s data system.


8. Track all pending enrollments for additional information needed for qualification.


9. Assist in the departmental compliance tasks which include the Working Aged Survey Mailing, Annual Notice of Change Letter, Health Care Risk Assessment mailings, and all other necessary compliance mailings.


10. Submit monthly reports to the Membership Manager, enrollment applications processed and returned, member appointments scheduled, and number of mailed packets and returned mail.

Supervisory Responsibilities

This job has no supervisory responsibilities.

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.

1. Education and/or Experience: High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.


2. Certificates, Licenses, Registrations: None required.


3. Other Qualifications:


4. Knowledge of Medicare Managed Care Plans.


5. Two to three years customer service experience.


6. Direct sales or related experience preferably in the Managed Care industry.


7. Bi-lingual (English/Spanish) required.

Skills and Abilities

1. 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.


2. 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.


3. 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.


4. Computer Skills: Strong computer skills.


5. Other Skills and Abilities:


6. Strong organizational skills.


7. Good telecommunications skills.


8. Attention to detail a must.

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.

1. 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.


2. The employee is frequently required to walk; stand; reach with hands and arms.


3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.


4. The employee must occasionally lift and/or move up to 20 pounds.


5. 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.