Company :Gateway Health Plan
Job Description :
This job oversees day-to-day activities of personnel and work processes to support Gateway Health Plan® Medicare Enrollment, Processes and Operations, and Broker Support including work prioritization, assignment of work to staff, training, and management of such work to completion. The incumbent works with internal and third-party service partners and vendors to assure accurate processing of enrollment and disenrollment related transactions and agent on-boarding. Responsible for overseeing call centers responsible for Member Enrollment, Premium Billing, and Broker Support, assuring that all established goal metrics are being met. Serves as subject matter expert for Medicare enrollment/disenrollment processing and agent on-boarding, including responding to internal and external audit requests.
- Must be able to communicate effectively both in writing and orally.
- Clearly communicate business requirements to direct reports.
- Clearly communicate with business partners.
- Actively participate in workgroups related to member retention and satisfaction.
- Provide direct oversight of personnel and processes responsible for Gateway Health Plan® Medicare product enrollment and disenrollment including enrollment and disenrollment data entry, chronic condition eligibility verification, late enrollment penalty investigation, change of plan, loss of special needs, and seamless enrollment processing. Includes monitoring or transactions for timeliness and accuracy. Look for opportunities to improve such processes.
- Provide direct oversight of personnel, systems and processes needed to support the Medicare product enrollments, sales agent on-boarding, commission payment and customer relationship management, including assuring that the systems communicate with each other effectively.
- Assure that files are processed in accordance with Federal and state regulations and guidelines.
- Work with department management and compliance personnel to assure that appropriate controls are in place to assure compliance.
- Provide direct oversight of personnel and processes responsible for decreasing the member voluntary disenrollment rate and increasing member satisfaction.
- Assist in the identifying, tracking and managing disenrollment statistics for each product. To increase member satisfaction ratings, takes the lead in managing preventive service campaigns.
- Provide direct oversight of the personnel responsible for the Medicare Process Administration enrollment and broker support call centers.
- Assure the call centers are adequately staffed; call-center personnel are adequately trained; and monitors calls for quality purposes.
- Responsible for assuring that Outbound Enrollment and Verification (OEV) calls are completed in a timely and compliant manner according to Centers for Medicare and Medicaid Services (CMS) guidelines.
- Review OEV guidance when issued and assures that telephone scripts, letters, and process are updated accordingly.
- Ensure staff is trained annually on the processes.
- Responsible for performing staff performance evaluations, coaching, and overseeing staff training.
- Responsible for assisting staff with the development of policies and procedures.
- Other duties as assigned or requested.
- High school diploma / GED
- 2 years of experience performing Medicare enrollment or sales support activities
- Bachelor’s degree
- 1-3 years of previous supervisory or lead position experience in a production environment
- Demonstrated skills as it relates to technical expertise and work prioritization, day-to-day staff oversight and problem solving, and technical counseling and coaching
- Experience with Gateway’s Enrollment and Agent Support systems
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Yes, number of direct reports: 14
Is Travel Required?
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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