Corporate
Manager, Enrollment & Eligibility
Chicago, IL, United States

 

The Manager of Enrollment and Mailroom Operations is responsible for accurate and expedient processing of all membership transactions of Medicaid, Commercial and Medicare lines of health plan benefit administration. The manager is also responsible for overseeing the handling and processing of incoming claims and other member correspondence in the mailroom.  This requires ongoing support and supervision of daily activities and deliverables. This includes, but may not be limited to: new business set-up, plan benefit changes, rate changes, file loads, modifications to enrollment for existing business, ensuring operational compliance with all relevant regulatory agencies, and operational service levels. The Manager is accountable for establishing and maintaining productive relationships with internal departments across Valence Health. The Manager is expected to represent Enrollment and Mailroom operations to clients and other internal and external stakeholders. At times the manager will be called upon to provide assistance to upper management for projects and special assignments. The Manager will identify and implement process improvement opportunities, while managing and developing a team. This position will report directly to the Director of Enrollment Operations.

Essential Functions
 

  • Manage supervisors, monitor team performance, and monitor operational deliverables for the team.
  • Identify and implement process improvement opportunities that lead to improved efficiency, accuracy and/or productivity.
  • Provide guidance for team and supervisors regarding escalations and help to proactively resolve issues before they occur.
  • Develop and implement effective training programs to ensure all team members are able to perform properly.
  • Ensure timely, accurate delivery, and maintenance of new and existing enrollment data, claim data entry, including system set-up, cross-departmental communication, standard reports, and exception reporting.
  • Develop knowledge in Centers for Medicare & Medicaid Service (CMS), Self-Funded, and all other applicable regulatory agencies that govern the enrollment data both received via electronic data interface (EDI) and non-EDI.
  • Manage the processes supporting reconciliation of group and agency enrollment data; report and resolve discrepancies.
  • Manages the various queues for claims processing and aligns resources within operations to meet specific turn-around-times (TAT)
  • Monitor workload fluctuations and adjust staff assignments accordingly both directly and by coaching supervisors.
  • Address concerns that may affect the morale and/or operational effectiveness of the group.
  • Monitor enrollment reports and claim aging reports to ensure staffing strategy is aligned with service level goals
  • Assist the director in developing the appropriate team performance metrics. In addition hold the team and supervisors accountable for those standards.
  • Hire for, develop and recognize the experience and knowledge/skills/abilities required for a successful team.
  • Act as a senior resource person for team members in all areas of the work and/or research to ensure accurate information is provided to team.
  • Assist the team in resolving administrative and routine operational issues as they arise. Serve as point of escalation with internal and external customers as necessary to resolve issues.
  • Promote the use of accepted best practices and innovative strategies.
  • Ensure operational compliance with all relevant regulatory agencies.
  • Assist the director in developing new operational processes and providing recommendations for improvements.
  • Keep abreast of changes in requirements.

Education and Experience
 

  • 4 year college degree or Associates degree with equivalent experience.
  • 3+ years of insurance experience in enrollment and eligibility
  • Experience in leading teams of 20+
  • Knowledge of health insurance coverage (Medicaid, Commercial and Medicare)
  • Outstanding communication skills and the ability to understand complex situations to effectively handle escalated customer needs
  • Analytical skills and the ability to read and interpret data
  • Problem solving abilities
  • Ability to operate computer programs; Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Outlook
  • Excellent oral and written communication skills
  • Ability to learn computer software system and use software to perform job
  • Familiarity and comfort with 834 files preferred

We are a work hard, play hard company, with a mission to help change healthcare. We are committed to treating our employees well, knowing that they in turn will treat our clients well, and help them provide higher quality, lower cost healthcare. With 1000+ employees located in Chicago and three other office locations, Valence Health is a small, but growing company doing big things.

 

 

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