Experience:
1-3 years of experience
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Employment Type:
Full time
Posted:
3/25/2016
Job Category:
Health Care Provider
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Enrollment and Retention Rep SHP (Spanish bilingual required)
Health Net, Inc. | Glendale, California
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Job Description

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Job Summary

The Enrollment and Retention Representative supports the education and enrollment of prospective Health Net Medicaid members statewide by providing benefit, eligibility and Health Net information and assistance for multiple Health Net State Health Program products.  The Rep gives education presentations over the telephone that may result in telephonic enrollments, in-home appointments, or a kit request with follow up call. The Rep places outbound calls to prospective members in response to leads received and maintains membership through retention activities. These retention activities include contacting county social services and DHCS enrollment vendor to determine barriers in member retention

The Representative is required to handle complex enrollment tasks such as priority issues from Regulatory agencies and County Social Service offices, advocacy inquiries or others from internal management.  Performance of these tasks involves the ability to research and resolve complex enrollment, eligibility issues to completion. This position also depends on excellent written and oral communication skills.  Additional responsibilities may involve assisting in system analysis and process improvement, training or back up to lead. Required to meet monthly enrollment and retention goals as established. This position is a bilingual position and all associates must speak, read, and write in Spanish and English.

Monday-Friday 10:00am-7:00pm

Essential Duties & Responsibilities

  • Demonstrates regular, reliable and predictable attendance.
  • Communicates with beneficiaries or other parties involved in the case, either by phone or letter.  Records inquiries, requests and responses while on call to track trends, create reports and document performance on all cases.
  • Identifies and researches complex enrollment issues and priority cases to increase membership and retain existing members.  Educates beneficiaries how to enroll with Health Net SHP.
  • Takes appropriate action to correct or resolve the priority case.  Assists members in connecting with other county agencies or the State enrollment contractor to help resolve enrollment and retention issues.
  • Analyzes system issues and makes recommendations for process improvements. In addition creates correction forms for discrepancies noted in any enrollment system.
  • Trains new associates and answers questions relating to eligibility, retention, benefits, rates, methodology, and underwriting. Also assists in the distribution of workflow, quality and production standards of the team.
  • Completes various administrative tasks, which may include mailing, faxing, updating databases, creating and maintaining group files, photocopying and microfilming.
  • Other duties as assigned.

Education

High School diploma or equivalent required; Two years college preferred, or equivalent work experience

Certification/Licensure Required

Must obtain Medi-Cal Sales and Marketing Certification and renew certification every other year.

Government Clearance & US Citizenship Requirement

Experience Required

 

  • Spanish bilingual required
  • Minimum two years in a related field or production environment with personal accountability for own work
  • Healthcare industry experience preferred
  • Three years administrative/accounting experience in a Health Insurance environment preferred
  • OR

    Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

Knowledge, Skills & Abilities

  • Ability to comprehend and follow detailed procedural guidelines
  • Ability to type minimum 35 wpm
  • Ability to focus and complete multiple tasks accurately in a production environment
  • Must be flexible and receptive to working with a team
  • Must have advanced PC skills, especially with Excel, Word and email, with spreadsheet and database experience
  • Ability to calculate and reconcile fee payments
  • Excellent communication skills including ability to clearly communicate with beneficiaries, representatives from the Regional Director’s office, and internal and external customers via letter or by phone
  • Excellent customer service skills required
  • Detail oriented with analytical skills
  • Excellent oral and written communication and phone presentation skills
  • Bilingual required, preferably Spanish

Working Conditions

  • The following section describes the general physical requirements for this position.  Please note that ‘constant’ refers to more than 81% of time; ‘significant’ refers to 40-80%; and ‘moderate’ refers to 20-40% of the time.
  • Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
  • Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
  • May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
  • May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
  • Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
  • Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
  • Required to have hearing ability to receive detailed information through oral communication.
  • Required to have speaking ability to express or exchange ideas.
  • Constant concentration may be required on various subjects by listening, reading and thinking clearly.
  • Interaction with others may be required.  May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required.  This may require face-to-face or telephone interactions.
  • Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
  • Constant computer usage including typing and/or eye strain. 
  • Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
  • Significant phone usage; headsets may be required.
  • Moderate lifting may be required.  May need to lift, carry and/or move equipment/supplies weighing up to 10 pounds, always using safe lifting techniques.
  • Constant amount of time spent working in a loud office environment with frequent interruptions/distractions.
  • Constant sedentary work (desk bound or seated).
  • Constant reading is required via computer screen and/or bound printed materials.

Disclaimer

DISCLAIMER:  The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job.  They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.

Location:

 

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Veterans/Disability

 

 

About Health Net, Inc.

Health Net, Inc. (Health Net) is an integrated managed care organization that delivers managed healthcare services through health plans and government-sponsored, managed-care plans. The Company operates and conducts its businesses through its subsidiaries. Health Net's health plans and government contracts subsidiaries provide health benefits through its health maintenance organizations (HMOs), insured preferred provider organizations (PPOs) and point-of-service (POS) plans to approximately 6.7 million individuals across the country through group, individual, Medicare, (including the Medicare prescription drug benefit commonly referred to as Part D), Medicaid, TRICARE and Veterans Affairs programs. The Company operates within two segments: Health Plan Services and Government Contracts. (Source: 10-K)

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