Enrollment Specialist I -Temporary (On-site), UPMC

UPMC Health Plan has an exciting opportunity for a Temporary Enrollment Specialist I position in the Medicare Enrollment department. This is a temporary position working Monday through Friday daylight hours and will be an on-site position located in Erie, PA. This position has a set rate of $20/hr.

Schedule:

Monday- Friday, between 7 a.m.- 5 p.m. Overtime required based on business needs. The Enrollment Specialist is responsible for the creation and maintenance of eligibility within the transactional system, responding to both internal and external customer inquiries, and resolving issues to meet or exceed service requirements. To successfully perform in this role, the Enrollment Specialist must have a strong understanding of enrollment regulations and complete all duties with strict adherence to established policies and procedures. This includes guidelines set forth by the Enrollment Services Manager, Centers for Medicare & Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID). The role also includes processing and maintaining all member-requested transactions, generating required correspondence to ensure compliant enrollment and disenrollment processes, and interacting with internal and external customers to resolve inquiries or complaints.

Responsibilities:

Understand detailed enrollment and disenrollment requirements and processing rules across products (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, National Complementary) and segments (Individual vs. Employer Group), including service area application. Maintain strict confidentiality of employee and member information. Analyze information to make accurate enrollment and disenrollment decisions in compliance with regulatory requirements. Collaborate with Sales staff to ensure all required application elements are received and resolve issues in a timely, compliant manner. Determine eligibility based on CMS (Part A/Part B), DPW (Medical Assistance), and/or PID requirements in alignment with election period guidelines. Accurately identify appropriate election periods through analysis of member history and regulatory guidance. Apply eligibility regulations to process transactions and generate required member correspondence; stay current on regulatory updates. Process enrollment and disenrollment transactions in accordance with company policies while meeting productivity and quality standards. Initiate and generate appropriate correspondence, including outreach requests and member letters, based on transaction type. Perform daily clerical tasks related to processing and electronic storage of member correspondence. Identify trends or areas of concern that may impact client satisfaction or regulatory compliance. Support Enrollment Services team initiatives and complete additional projects as assigned.