MBE Specialist - Medicare

Minneapolis, Minnesota
Sep 03, 2021
Jan 09, 2022
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Work Location: In the office, work-at-home or hybrid (in the office 3 or more days per week)

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible for complex enrollment processes. Meet the needs of the department through distribution of workload and a focus on timely, accurate deliverables. Research complicated enrollment issues and/or member concerns. Collaborate directly with members and/or other UCare staff to resolve issues and respond to internal and external inquiries. Must maintain a thorough understanding of the enrollment processes and systems to support Representatives and Seniors as requested. Responsible for monitoring and ensuring enrollment data files are uploaded accurately and completely. Maintain a working knowledge of UCare products and ensures that all internal systems, vendors, State and CMS are in sync. Serve as day-to-day liaison for regulators and agencies such as: CMS, DHS and MNsure. Specialist will be assigned to a product team as their primary focus; however, work will not be restricted to one product depending on the department needs.

• Maintain a thorough understanding of duties and responsibilities of the Representative role and the Representative Senior role to ensure appropriate back up support as requested.

• Demonstrate and maintain working knowledge of our products, our core operating systems and the detailed procedures to process enrollment and billing, ensuring regulatory and contractual obligations are met and internal policies and procedures are followed.

• Assist with development, implementation, and managing the processes for identifying and tracking members to ensure compliance with CMS, DHS and/or MNsure regulations. Assist with maintaining the process for tracking all TRR codes and following CMS guidance.

• Maintain and complete letters daily and with-in CMS TAT's for all products. Complete the error reports received via MAT and reconcile dental and LIS's updates. Ensure that the data received is accurate and active.

• Perform reconciliations of SNP-MSHO and SNBC CMS Enrollment/Disenrollment's with CMS and DHS. Includes creating documentation to be submitted to the CMS Regional Office/Reed and Associates, matching of expected Enrollments and Disenrollment based on UCare's core operating system data, DHS and CMS.

• Verify and work daily enrollment reports from the vendor systems and monthly state membership files.

• Load enrollment membership files for products, investigate and resolve errors to ensure members are accurately enrolled. Ensure accurate and timely submission of membership information.

• Reconcile daily enrollment reports/files to ensure that enrollment data has been processed and loaded - identify discrepancies and work across the team to resolve. Research members on Mnsurehold and Member on Review (MOR) to ensure accuracy and resolving discrepancies. Create suppress files as needed to maintain eligibility. Complete outreach calls as needed.

• Research and support member services, CAG, Sales and Billing in resolving and responding to complex reconciliation issues and dual eligible issues. Research and verify member eligibility

• Provide support to other enrollment staff by answering questions and providing 1:1 training when appropriate

• Respond to Service Form inquiries and written requests from members including from the CMS reconsideration vendor regarding a beneficiary request for appeal of LEP.

• Submit appropriate changes from vendor to CMS, track for return on TRR and send appropriate correspondence to member.

• Review and reconcile all ESI pre-edit reports for the TRR's and the ESI elig file. Maintain ESI eligibility updates for pharmacy across all lines of business.

• Download MSHO and SNBC TRR's daily from Gentran and download them into MRRS Enrollment. Review CMS guidance on TRR processing. When updates are received make appropriate changes to our process.

• Participate in process and quality improvement, department initiatives/plan and employee engagement. Provide input into department policies and procedures, including creating and maintaining Step by Steps work instructions.

• Meet or exceed department quality assurance expectations.

• Assist in departmental reporting and communication to other UCare departments.

• Other projects and duties as assigned.


Four-year degree in Business or related field; demonstrated experience may be considered in lieu of degree.

Required Experience

Three years' experience in a healthcare setting or a health insurance plan. Advanced experience with Excel spreadsheets and mail merge. Experience in researching and resolving complicated issues. Customer/Member engagement. Experience with Advantasure or HealthRules.

Preferred Experience

Experience working with Medicare, MNSure or Medicaid. Microsoft teams.


The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 09/02/2021

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