Job Requisition ID: 9614
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Position Summary/Position
Under the direction of the Enrollment Assistance Manager, the Enrollment Specialist is responsible for providing full-service application assistance to the uninsured, including screen for program eligibility, complete a Covered California or Medi-Cal application, and submit the application to Covered California or Medi-Cal Office on behalf the applicant. The Enrollment Specialist will follow-up on the submission to ensure the application is processed and a final decision is made on applicant's eligibility. The Enrollment Specialist will also outreach to auto-enrolled Covered California Members to help effectuate their membership. For newly enrolled Medi-Cal beneficiaries who want to enroll with IEHP, the Specialist will assist to complete a Health Plan Choice Form to be submitted for State approval. Additional responsibilities include inbound and outbound sales calls and follow-up calls to help potential Members apply for Covered California and/or Medi-Cal. The Enrollment Specialist will also support external off-site enrollment events upon request.
Major Functions (Duties and Responsibilities)
1. Strive to live and practice IEHP’s Mission, Vision and Values (MVV) every day, and strongly commit to advance the organization’s strategic plan.
2. Consistently meet or exceed daily, weekly, and monthly quotas for providing screening and/or application assistance, for inbound and outbound calls.
3. Provide excellent customer service during telephone screening and/or application assistance for Covered California, Medi-Cal, and other state health programs including conducting outbound sales campaigns to Members and the public.
4. As appropriate, complete applicable application form, while the customer is on the phone, then provide instruction for all related follow-up procedures and processes.
5. Provide in person assistance and/or application completion to any potential Member who walks in and requests enrollment assistance, application completion and/or information.
6. Qualify candidates by calculating their household income and by using other approved qualification methods and worksheets.
7. Advise candidates of the documentation required to complete the application and answer questions and issues about the enrollment process.
8. Provide Member guidance of key health plan benefits related to a Covered California and Medi-Cal plan
9. Outreach to auto-enrolled Covered California Members to help effectuate membership.
10. Complete all assigned reports or documentation to facilitate the successful enrollment into a designated program to include qualification worksheets, applications, appropriate letters, instructions to potential candidates and daily/weekly activity reports.
11. Communicate with Members utilizing translation applications/programs via applicable devices when candidates speak other languages and/or have a disability.
12. Assist in the development and training of new Enrollment Specialists, as needed.
13. Participate in planning discussions and meetings. Assist in providing input in quality improvement processes and tactical plans to support outreach, enrollment, and retention goals.
14. Respond to all incoming and outgoing mail and complete other administrative unit duties assigned.
15. Document all calls in detail to create a recorded history for future interaction with each Member with Customer Relationship management (CRM) database. Present cases and work with a manager in resolving potential Member issues.
Major Functions (Duties and Responsibilities) Cont
Supervisory Responsibilities
Experience Qualifications
- In-house sales
- Outbound Sales Experience
- High-volume telemarketing
- High-volume consumer products/industrial distribution order taking
- Customer Service in a high-call-volume environment
- Outreach, Enrollment and Retention
Preferred Experience
Bilingual - written and verbal skills preferred. The Team Member that has the preferred experience must take a language proficiency assessment and must receive a passing score.
Education Qualifications
High School diploma or GED required.
Preferred Education
Professional Certification
Certification/License from Covered California (California's Health Exchange) to conduct Covered California and Medi-Cal Application is required.
If not possessing a Certification at the time of hire, the candidate is required to obtain this Certification within six (6) months after been hired. This Certification needs to be renewed annually through an annual certification process conducted by Covered California.
Professional Licenses
Drivers License Required
Knowledge Requirement
- Medi-Cal and/or Covered California eligibility
- Customer service and phone etiquette
- State Health Programs and the application and enrollment process.
- Both Open and Special Enrollment Period eligibility requirements.
Skills Requirement
Skilled in data entry.
Abilities Requirement
Superior time management and organization habits. Must be courteous, friendly and customer oriented. Must have the ability to multi-task in a high-pressure environment while maintaining a high level of performance. Must be an independent self-starter who effectively communicates parameters of a Health Program within the guidelines of a defined script. Ability to maintain professionalism and IEHP’s Mission serving our members when experiencing difficult calls.
Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions
Will work a normal (8 a.m. - 5 p.m. or 9 a.m. - 6 p.m.) workday with some weekends, but work schedules and hours may vary depending upon department needs and Renewal/Enrollment Periods. The Enrollment Specialist will be provided at least one week’s notice when a managerial change of a work schedule and/or hours is required.
Word processing and data entry involving computer keyboard and screens.
Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership.
Work Model Location
Physical Requirements
A reasonable salary expectation is between $48,110.40 and $59,425.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
