Enrollment Specialist
- Marshfield, WI
- Permanent
- Full-time
WORK LOCATION: Fully On-siteSHIFT: Monday - Friday 8am - 5pmREQUIRED EXPERIENCE:
-HS Diploma or equivalent Required
-Intermediate level of Microsoft work or Excel required
-1 year experience in office setting with basic administrative skills including Microsoft Word and Excel Required
-Excellent oral and written communication skills RequiredPREFERRED EXPERIENCE:
-Additional college or technical school in business or insurance preferred
-1-2 years in Insurance processes or finance preferredPOSITION TITLE: Membership Support Processor - SHPJOB SUMMARY
The SHP Membership Support Processor is responsible for processing eligibility additions,
modifications and terminations. This includes resolving all billing and accounts receivable issues. Also
responsible for applying Centers for Medicare and Medicaid Services (CMS) regulations and policies to
each Advocare enrollment and disenrollment request. Provide additional support as needed for all
enrollment functions.ESSENTIAL JOB FUNCTIONS
1. Reviews all incoming member and employer group materials. Determines and records appropriate
identification number. Verifies and/or updates demographic information as appropriate.
2. Determines enrollment periods, pre-existing condition expiration dates and creditable coverage.
Processes eligibility additions, modifications and terminations. Establishes appropriate billing
method.
3. Works with member, employer group, agent and CMS to resolve any outstanding questions.
4. Reviews and approves enrollment reports prior to weekly transmission of eligibility files to CMS.
5. Analyzes and resolves billing and accounts receivable issues for members regarding premium
payments and delinquent accounts. Posts member premium payments. Audits and monitors
monthly premium billings and collects on all delinquent accounts.
6. Documents all verbal and written contacts.
7. Regular attendance is required in order to carry out the essential functions of the position.
8. Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge
and abilities to perform, within scope, role specific functions.ADDITIONAL DUTIES
1. Other duties as assigned.JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be
from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.Minimum Required: Intermediate level of Microsoft Word and Excel classes required, or must
demonstrate equivalent expertise.Preferred/Optional: Additional college or technical school classes in business or insurance.EXPERIENCE
Minimum Required: Minimum of one year experience in office setting with basic administrative
skills, including data entry, Microsoft Word and Microsoft Excel. Excellent oral and written
communication skills.Preferred/Optional: One to two years' experience in insurance processes or finance.PATIENT POPULATIONS SERVED
Individuals hired are expected to serve patients of different ages, backgrounds, etc. When performing
the essential functions of the role, the individual must identify the patient age group to be served and
apply the appropriate care based on the patient's age and background. The hiring manager is
responsible for communicating the patient population generally encountered in the role and is
responsible for ensuring the appropriate cultural, age and related training needed to serve the patient
populations.