Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
This position performs activities associated with Enrollment operations for the Health Plan. This includes maintaining enrollment information in the Health Plan transaction system accurately and effectively. This position involves the verification of enrollment information, researching problems, and resolving issues associated with enrollment of beneficiaries. The Enrollment Specialist works as an integral part of the enrollment team ensuring a smooth customer experience at all touch points and through the enrollment process both of existing members and beneficiaries enrolling in the plan.
Job Description
Key Outcomes:
- Enrolls eligible members in the transaction system within the departmental standard time frame to ensure Health Plan members can receive access to care benefits in a timely manner.
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- Management of verification, application, outreach and response to account related activities to include applicable discounts, penalties, etc. Accurately and effectively processes and responds to all basic enrollment activities and interdepartmental communications. Maintenance and management of all document scanning, maintenance and accuracy of information entered in the document management system. Provides routine audit support of such documents to ensure accuracy and availability of the information.
- Effectively communicate with current and potential members through written and phone communication as needed of enrollment changes, eligibility status, etc. or conducts outreach to members regarding account status
- Serves as a mentor and learning resource regarding the basic enrollment process
- Enhanced partnership and collaboration with the Sales and Member Engagement teams to ensure accurate enrollment processes. Fully knowledgeable about all related health plan products, enrollment and payment pre-requisites for the variable requirements
- Partners with Enrollment leadership and training to create, updated departmental policies, procedures and workflows. May help create basic, effective and efficient workflows.
- Represents the department in interdepartmental work groups regarding basic enrollment functions
- Continuously seeks to gain improved efficiencies with new technology and process improvements
- Maintains basic auditing skill set to monitor day to day data accuracy of member eligibility and payment data maintained in the system
Education/Experience:
- High school diploma or equivalent required; Post-secondary education preferred.
- Experience in a health care/HMO organization preferred.
- Experience in a customer service or customer facing role preferred.
- Familiarity with company policies, administrative and managerial contracts, the DOD managed care contract preferred.
Requirements:
Terms of employment may require the applicant/incumbent to qualify, obtain and maintain a Position Level of Trustworthiness from the U.S. Government Office of Personnel Management. Additionally, this position may require the applicant/incumbent to be a U.S. citizen.
Skills/Knowledge/Competencies (Behaviors):
- Knowledge of basic enrollment processes and requirements for all health plans to include how premiums are impacted by member status.
- Strong understanding of premium requirements
- Basic knowledge of all vendor interfaces and can assess vendor reporting for gaps and notify Management with concerns
- Proficiency in MS Office (including Word, Excel, PowerPoint, and w/Outlook) Visio and desktop publishing and database software preferred along with familiarity with the Internet.
- Demonstrates an understanding of and alignment with Martin’s Point Values.
- Strong organizational skills (ability to prioritize, multi-task, and meet deadlines).
- Ability to handle confidential and sensitive information in a discreet and professional manner.
- Ability to collaborate with team members and all internal departments.
- Ability to function independently (good sense of judgment).
- Must be able to work a flexible schedule, including weekends and holidays when necessary
There are additional competencies linked to individual contributor, provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org
