Eligibility Representative III

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose:
Processes and maintains eligibility information for specialized and/or large group accounts. Acts as liaison for assigned groups/members and reconciles enrollment and processing. Provides mentoring and training to less experienced representatives.

• Reviews and processes enrollment documents submitted by employer groups.

• Troubleshoots escalated and/or complex eligibility issues for immediate resolution.

• Responds to all written and telephone eligibility inquiries from internal (e.g.

• Member Services, Sales, Underwriting, Appeals and Grievance, Compliance) and external (e.g. employer groups, members CMS, DHS) customers.

• Identifies membership discrepancies, eligibility issues, and group contract issues for resolution by Service Representatives.

• Provides and documents continuous follow-up on open issues.

• Tracks, reviews and manually processes submitted enrollment transactions.

• Reviews eligibility reports and identifies all changes to eligibility (additions, terminations, and/or contract changes) and processes all resulting transactions.

• Compiles data and prepares reports reflecting daily statistics on new incoming forms and pended forms for distribution within department and to management.

• Provides project support, new hire training and coordination of open enrollment processing as needed.

• Participates in system consolidations as needed.

• Performs other duties as assigned.

• Complies with all policies and standards.

Education/Experience:
High School Diploma required; Post high school course work in Business or Accounting helpful. Three to four years of combined membership eligibility and health insurance experience. Experience within HMO/ Health care industry preferred. Enrollment experience strongly preferred.

 

Pay Range: $19.04 - $32.35 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act