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Enrollment / Eligibility Representative - San Bernardino, CA or Los Angeles, CA

Job Location:
San Bernardino, CA
Metro Area:
CA - Los Angeles
Company Name: UnitedHealth Group
Website:  Click to Visit
UnitedHealth Group
Position Description: Working in Operations at UnitedHealth Group is one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.If it sounds too good to be true, consider this: Through our family of businesses and a lot ofinspired individuals, we're building a high-performance structure that works better for morepeople in more ways. Position Responsibilities: Process all health plan electronic eligibility files (full and change) to update MARCH Vision Care (MARCH) membership. Review results of database updates from various electronic sources and take corrective actions if needed. Coordinate with health plans to ensure timely submission of eligibility files and ensure that file specifications are current. Perform all database maintenance related to electronic data interchange to ensure accurate eligibility in support of accurate claims, authorization, and confirmation transaction record processing. Take corrective actions determined by review of system (exception, reconciliation and ad hoc) reports to ensure system data integrity. Update MARCH reference materials including health plan contact and file information and processing documentation as business needs change. Maintain detailed file processing logs and summary logs and transmit log reconciliation files to health plan partners. Analyze raw files to determine reason(s) for inload errors including ability to determine the location where the file load error occurred. Ensure all eligibility load errors are identified and resolved to prevent similar discrepancies on future eligibility loads, when possible. Answer eligibility calls and make necessary updates in support of internal and external customers. Interact with various internal and external departments such as: Claims Unit Ensure all claim member denials for member ineligibility are verified with the health plan prior to being finalized. Information Technology Ensure all system issues impacting timely posting of enrollment information are resolved within timeframes required to meet MARCH service level agreements. Health Plans - Ensure eligibility files are received by MARCH at the agreed upon intervals and meet the agreed to file format specifications. Transmit file posting logs to communicate posting times and record count reconciliation information.Other Departments As it relates to proper member eligibility assignment. Responsible for data encryption, decryption and downloading eligibility data from internet or FTP sites.


Required Qualifications: High School Diploma / GED 2+ years of customer service experience Basic navigation skills with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document), and Microsoft Outlook (ability to send emails) Preferred Qualifications: Understanding of HMO / PPO eligibility process between health plans and delegated entities Entry-level experience with SQL queries is preferred Some college experience in computer science, healthcare administration, or business administration Soft Skills: Data analysis skills Communicate effectively in a clear and concise manner Physical Requirements and Work Environment: Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: claims, HMO, PPO, customer service, call center, insurance, providers, health plans, healthcare, United Healthcare
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