Membership Rep II (TEMPORARY)

Location: Orange, California US

Notice

This position is no longer open.

Job Number: 4415

Position Title: Membership Representative

External Description:

Summary

The Membership Representative II performs daily operations regarding member disernollments, retro processing, reinstatements and Out of Area (OOA). Ensures members are properly process within Centers of Medicare and Medicaid (CMS), the third party vendors and EZ-Member.

Essential Duties and Responsibilities

Essential duties and responsibilities include but are not limited to:

  1. Processes all disenrollments from the Weekly TRR and Monthly. Ensures we have the correct documentation in EZ-Member.
  2. Ensure all correspondence is mailed to members on a timely manner.
  3. Reviews on a weekly basis the Weekly TRR. Follows up with any pending enrollments or rejections.
  4. Submits in a timely manner to the 3rd party vendor any retro disenrollments, cancellation, retro enrollments, reinstatements and OOA’s. Ensures they are processed correctly.
  5. Monitors all submission to 3rd party vendor ensures all submissions are processes within the correct time frame.
  6. Submits monthly reports to the Membership Director of Monthly submissions to 3rd party vendor including OOA, Retro Enrollments, Retro Disenrollments and Reinstatements
  7. Ensures all members outside of the service area are processed on a timely manner and ensure the letters are mailed with in CMS guidelines in order to be compliant.
  8. Act as liaison representative to the Sales Representatives. Provide any issues identified to the necessary internal department heads.
  9. Assist in the departmental compliance tasks which include the Mailing, Annual Notification of Coverage Letter and any other necessary compliance mailing.
  10. Performs other duties as assigned.

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 years related experience and/or training; or equivalent combination of education and experience.
  2. Certificates, Licenses, Registrations:  None required.
  3. Other Qualifications: 
    1. Knowledge of Medicare Managed Care Plans.
    2. Two to three years customer service experience.
    3. Direct sales or related experience preferably in the Managed Care industry.
    4. Bi-lingual (English/Spanish) required.
    5. Must be familiar with CMS MMR and TRR files

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:
    1. Strong organizational skills.
    2. Good telecommunications skills.
    3. Good organizational skills.

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.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Membership Rep II (TEMPORARY)

Company Profile:

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.

EEO Employer Verbiage:

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster.  If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions.  This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].