Hybrid Enrollment Representative (Orange, CA)
Core
Manages new plan enrollments, validates data from CMS files, and ensures compliance with Medicare guidelines for seniors and chronically ill patients.
Role type
Enrollment Representative
Builds
Enrollment data and compliance reports for Medicare Advantage plans
Domain
Healthcare / Medicare Managed Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Data entry, Medicare guidelines knowledge, CMS file validation, correspondence management, report generation, problem-solving
Preferred skills
Direct sales experience, Managed Care industry experience, MBA, Bilingual (English/Spanish)
Technologies
CMS systems, Plan data systems
Responsibilities
Research and validate enrollments from error reports and CMS daily files; Send correspondence to Members or CMS to gather information or provide updates; Submit daily transaction files to CMS; Ensure enrollments meet Medicare guidelines; Act as a liaison to Sales Representatives; Conduct data entry of enrollment applications and disenrollments; Track pending enrollments; Assist in departmental compliance tasks; Submit monthly reports to the Membership Manager
Seniority
Individual Contributor, entry to mid-level