Enrollment Representative II (HNGS)

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.Position Purpose: Under general supervision, the Enrollment Representative II processes and maintains enrollment information for TRICARE beneficiaries in accordance with applicable laws, rules, and contracts. Researches and resolves intermediate level inquiries from other departments, Government personnel, other contractors, and beneficiaries. Demonstrates regular, reliable and predictable attendance. Processes new enrollment applications, change requests, plan changes and voluntary disenrollments by validating beneficiary eligibility status, applying government mandated policies and procedures, and keying relevant enrollment record information into government systems. Determines appropriate Primary Care Manager (PCM) assignment by analyzing and applying complex Memorandum of Understanding (MOU) contract rules. Develops and maintains a comprehensive knowledge of all Health Net Enrollment policies and procedures as well as TRICARE plan types and Government policies. Multitasks between various TRICARE plan types (Prime, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, TRICARE Plus, etc.) throughout the day while maintaining accuracy, compliance and production standards. Maintains strict compliance timeliness standards through online workflow system and assigned workflow queues. Takes initiative and uses sound judgment in alerting management to non-standard enrollment requests that may jeopardize beneficiary health care coverage. Initiates telephone or written letter contact, utilizing the letter writing system, for application development or other communication with beneficiary in order to disclose or obtain important enrollment information. Documents appropriate enrollment actions and other relevant information in various system applications. Researches and resolves audit discrepancies. Must meet or exceed departmental standards for quality, productivity and teamwork. Researches and responds to priority/escalated cases. Mentors other Enrollment Representatives. Provides input for enrollment related policies and procedures. Works closely with Supervisor or Lead to identify and implement process improvement opportunities. May assist with testing new processes/procedures and system enhancements. May serve as back up to Enrollment Rep III/Lead. Tracks individual production via a production database. Other duties as assigned.Education/Experience: High School diploma or equivalent required; college course work a plus. One year experience as an Enrollment Representative I or equivalent experience. Two to three years in a related field or production environment . Health care experience preferred.Government Security/Clearance/Citizenship Requirements: Requires US citizenship and current security clearanceOur Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.TITLE: Enrollment Representative II (HNGS)LOCATION: Various, MissouriREQNUMBER: 1422721