Customer Service Representative I - Medicaid Enrollment, Geisinger Health Plan (resident in Eastern Standard Time Zone)
Core
Resolves enrollment eligibility issues, processes member terminations, and reviews claims for coverage under Medicaid and health plan policies.
Role type
Customer Service Representative (Enrollment & Claims)
Builds
Membership data reports and eligibility determinations for Geisinger Health Plan members and employer groups.
Domain
Healthcare / Insurance / Public Health (Medicaid)
Deliverable
client delivery
Required skills
Policy interpretation, eligibility determination, claims review, data extraction, communication
Preferred skills
Cross-training, process improvement, team support
Technologies
Online software capabilities, employer group modules
Responsibilities
Resolves and reconciles enrollment reports and eligibility issues; Initiates communication to newly enrolled members and employer groups; Determines eligibility and processes terminations; Reviews suspended claims for resolution; Prepares and disseminates enrollment activity letters; Researches claim issues from providers for reconsideration.
Seniority
Entry-level, individual contributor
