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Enrollment Lead

Company: Santa Clara Family Health Plan
Location: San Jose
Posted on: September 15, 2020

Job Description:

Salary: $25.79 - 38.69

Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D)

Department: Enrollment and Support Services. Reports To: Manager, Enrollment and Support Services. Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521. GENERAL DESCRIPTION OF POSITION. The Enrollment Lead assists department staff in resolving complex eligibility and enrollment issues; leads and participates in projects and tasks to support and improve the operations of the Department; and provides timely data entry, tracking, validation, monitoring, reporting and supporting communications to maintain accurate enrollment, eligibility and premium data for all lines of business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and SCFHP business requirements, to achieve Department performance objectives.. ESSENTIAL DUTIES AND RESPONSIBILITIES. To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.. Act as back-up to Enrollment Coordinators during times of high volume work and/or staffing shortages to ensure compliance with all applicable state and federal regulatory requirements.. Monitor workflows and serve as initial point of escalation for staff in handling complex issues; research, troubleshoot and resolve issues using available resources and within established guidelines; ensure appropriate resolution, escalation, and/or follow up occurs within specified timeframes.. Process all program applications (new and renewal), disenrollment requests and premium payment transactions within required timeframes; includes providing members with application assistance and processing all associated correspondence.. In response to internal and external inquiries and in support of initiatives, work collaboratively with others to analyze, verify and resolve enrollment, eligibility and premium billing issues in an accurate, timely, respectful, professional and culturally competent manner; communication may be via inbound call, outbound call, in-person, fax, email, mail, or other appropriate communication channel.. Accurately document and code all contacts and follow-up actions for member, provider and other communications and activities in accordance with established guidelines.. Track, analyze, validate and process all daily, weekly, and monthly enrollment and membership eligibility, integrity, audit, reconciliation/validation, and error reports accurately and in a timely manner.. Identify, investigate, troubleshoot, resolve and report eligibility and enrollment issues, errors and/or discrepancies.. Prepare and submit all required internal and external reporting, including dashboards.. Ensure process for delivering member materials to new and existing members is completed accurately and within the required timeframe.. Create, maintain and use operating instructions and tools needed to support department activities and to ensure compliance with all regulations.. Provide direct support for new member enrollment and for member retention via inbound and/or outbound calling.. Guide and mentor Department staff as a role model, leading by example. Assist with new hire training by having new hires shadow, observe and listen to calls, in accordance with training guidelines and protocols. Observe new hires and provide feedback to Department Manager.. Work with Department Manager to complete projects within specified timeframes.. Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.. Identify issues and trends (data, systems, member, provider, other), as well as general departmental questions/concerns; report relevant information to management; make recommendations.. Provide input and support for implementation/upgrade/improvements of internal systems that support department processes; includes but is not limited to identification of issues and opportunities for improvement, providing input to requirements, development of test plans and test cases, conducting testing, and reporting results and potential defects.. Perform other related duties as required or assigned.. REQUIREMENTS – Required (R) Desired (D). The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.. High School Diploma or GED. (R). Associate’s Degree,. Minimum three years of experience in a health plan in jobs requiring interaction with members. (R). Proficient in all aspects of enrollment and eligibility related activities for all SCFHP lines of business. (R). Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support Department operations as dictated by business needs. (R). Ability to conduct all necessary research to accurately resolve complex issues and provide guidance to Department staff. (R). Ability to lead by example and support the team on complicated issues. (R). Work weekends and company holidays as needed based on business and regulatory requirements. (R). Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R). Ability to use a keyboard with moderate speed and a high level of accuracy. (R). Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP members and providers over the telephone, in person or in writing. (R). Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R). Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R). Ability to maintain confidentiality. (R). Ability to comply with all SCFHP policies and procedures. (R). Ability to perform the job safely with respect to others, to property, and to individual safety. (R). WORKING CONDITIONS. Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.. PHYSICAL REQUIREMENTS. Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R). Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R). Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R). Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment; (R). Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R). Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R). ENVIRONMENTAL CONDITIONS. General office conditions. May be exposed to moderate noise levels.. EOE. Santa Clara Family Health Plan - Today - save job. Get job updates from Santa Clara Family Health Plan. Santa Clara Family Health Plan (SCFHP) is a local, public, not-for-profit health plan dedicated to improving the health and well-being of.... Thousands of employers search for candidates on Indeed

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Keywords: Santa Clara Family Health Plan, San Jose , Enrollment Lead, Other , San Jose, California

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