Humera - Administrative and Professional Staffing

Enrollment & Eligibility Process Specialist

Minnetonka, MN, United States
Contact For Rate
Mar 14, 2018
Mar 17, 2018
Job Type
Employment Status
Full Time
Humera is in search of an Enrollment & Eligibility Process Specialist for our client in Minnetonka. The Enrollment & Eligibility Specialists are responsible for application processing, member maintenance administration (including both off and on Exchange policies), payment processing, mail/fax processing and internal and external (member facing) email monitoring. Also, notifying brokers, applicants, members and vendors of additional information required for an application or a requested policy update. Enrollment & Eligibility Specialists write customized letters as needed, assist other teams if help is needed, and identify broker and insides sales training needs, as well as needed communications enhancements. The majority of work is done in Personal Plan Portal (PPP) and Health Rules, with occasional communications with UHG. This is a long term contract opportunity!
Training and Process Improvements - 10%

  • Supports the training of internal staff on processes (as needed)
  • Identifies and recommends process improvements and works with the Call Center, Medica IT, and vendors to implement enhancements

Inventory Control, Compliance & Accuracy - 15%

  • Monitors incoming applications and payment volumes to ensure timely processing on member?s behalf and to ensure swift on-boarding of members
  • Monitors the enrollment process and turn-around times
  • Verifies that transactions comply with internal financial and external regulatory policies and procedures
  • Ensures accurate documentation and record management of processed invoices, ACH forms, and applications
  • Complies with regulatory and Medica requirements to protect the confidentiality, integrity, and security of all protected health information and financial files
Enrollment processing - 25%
  • Processes fax/mail/email inquires
  • Verifies application eligibility verification & completes data entry of applications
  • Initiates ACH set-up & processing on member?s behalf
  • Monitors and procesess pending application clean-up within the Personal Plans Portal
  • Researches and resolves issues related to applications and enrollment from Brokers, Sales, and Customer Service; communicates findings to necessary parties
Payment Processing & Billing Processes - 25%
  • Processes recurring payments and postings, including calculating split check payments
  • Investigates unmatched payments and posts to member accounts as applicable
  • Conducts post bill run audit to ensure correctness of member invoices Member Maintenance & Customer Support - 25%
  • Performs maintenance to member policies through email, fax and/or HealthRules workbasket requests
  • Reviews member policies for termination/cancellation and initiates member correspondence
  • Reviews daily/weekly data cleansing report to update member policies to maintain data integrity
  • Serves as subject matter expert to internal and external business partners
  • Assists members, brokers, sales with basic enrollment and payment processing requests/inquiries


  • Minimum education level required to qualify for the position: Associate's degree or related experience
  • Minimum years' experience required in the field to qualify for the position: 6 months in a related field


  • Solid understanding of the enrollment, billing, and related data • Proficiency with Windows applications including MS Excel and MS Word
  • Attention to detail and high level of accuracy
  • Strong problem solving and decision making skills
  • Keyboarding accuracy
  • Strong customer focus
  • Can effectively troubleshoot issues
  • Strong communications and relationship skills for communications with the all business partners
  • Strong quantitative reasoning skills
  • Attention to detail
  • Able to work independently
  • Able to multi-task

    M - F 8:00AM - 4:30PM

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