Introduction to Centene and Our Mission
At Centene, we are dedicated to transforming the health of our communities, one person at a time. As a diversified, national organization, we offer a unique blend of career opportunities, competitive benefits, and a fresh perspective on workplace flexibility. With 28 million members relying on us for their health insurance needs, we are committed to providing exceptional service and support. Our team is passionate about making a difference, and we are looking for like-minded individuals to join us on this journey.
Job Overview
We are seeking an experienced Eligibility Representative III to join our team in a fully remote capacity. This role offers the flexibility to work from anywhere, providing a better work-life balance and the opportunity to contribute to our mission from the comfort of your own space. As an Eligibility Representative III, you will play a critical role in processing and maintaining eligibility information for specialized and large group accounts, acting as a liaison for assigned groups and members, and reconciling enrollment and processing issues.
Key Responsibilities
- Reviews and processes enrollment documents submitted by employer groups, ensuring accuracy and completeness.
- Troubleshoots escalated and complex eligibility issues, providing immediate resolution and exceptional customer service.
- Responds to written and telephone eligibility inquiries from internal and external customers, including member services, sales, underwriting, appeals, and grievance, compliance, employer groups, members, CMS, and DHS.
- Identifies membership discrepancies, eligibility issues, and group contract issues, providing continuous follow-up on open issues and documenting all interactions.
- Tracks, reviews, and manually processes submitted enrollment transactions, ensuring timely and accurate processing.
- Reviews eligibility reports, identifies changes to eligibility, and processes resulting transactions, maintaining accurate and up-to-date records.
- Compiles data and prepares reports reflecting daily statistics on new incoming forms and pended forms, providing insights and recommendations for process improvements.
- Provides project support, new hire training, and coordination of open enrollment processing as needed, demonstrating expertise and leadership skills.
- Participates in system consolidations as needed, adapting to changing systems and processes with ease.
Essential Qualifications
To be successful in this role, you will need:
- A High School Diploma, with post-high school coursework in Business or Accounting being highly desirable.
- Three to four years of combined membership eligibility and health insurance experience, with experience within the HMO/healthcare industry being preferred.
- Strong analytical and problem-solving skills, with the ability to troubleshoot complex eligibility issues and provide immediate resolution.
- Excellent communication and customer service skills, with the ability to respond to written and telephone inquiries from internal and external customers.
- Strong organizational and time management skills, with the ability to prioritize tasks and manage multiple projects simultaneously.
Preferred Qualifications
While not essential, the following qualifications are highly desirable:
- Experience working in a remote or virtual environment, with the ability to self-motivate and work independently.
- Strong technical skills, with experience using eligibility systems and software applications.
- Knowledge of healthcare regulations and laws, including HIPAA and ACA.
- Certifications or training in eligibility, membership, or health insurance, demonstrating a commitment to ongoing learning and professional development.
Skills and Competencies
To excel in this role, you will need to demonstrate the following skills and competencies:
- Attention to detail: The ability to accurately process and maintain eligibility information, with a high degree of accuracy and attention to detail.
- Communication skills: The ability to effectively communicate with internal and external customers, providing exceptional customer service and support.
- Problem-solving skills: The ability to troubleshoot complex eligibility issues, providing immediate resolution and exceptional customer service.
- Organizational skills: The ability to prioritize tasks, manage multiple projects simultaneously, and maintain accurate and up-to-date records.
- Technical skills: The ability to use eligibility systems and software applications, with a strong understanding of technical concepts and terminology.
Career Growth Opportunities and Learning Benefits
At Centene, we are committed to the growth and development of our employees. As an Eligibility Representative III, you will have access to a range of career growth opportunities, including:
- Professional development: Ongoing training and development opportunities, including certifications and training programs.
- Career advancement: Opportunities for career advancement, including promotions and lateral moves.
- Mentorship: The opportunity to mentor and train less experienced representatives, sharing your expertise and knowledge.
- Cross-functional training: The opportunity to work on special projects and assignments, gaining experience and knowledge in different areas of the business.
Work Environment and Company Culture
At Centene, we pride ourselves on our positive and inclusive work environment. As an Eligibility Representative III, you will be part of a dynamic and supportive team, with a strong focus on:
- Teamwork: Collaborative and supportive team environment, with a focus on achieving common goals.
- Diversity and inclusion: A commitment to diversity and inclusion, with a focus on creating a welcoming and inclusive work environment.
- Work-life balance: A focus on work-life balance, with flexible working arrangements and a range of employee benefits.
- Recognition and reward: A culture of recognition and reward, with opportunities for bonuses, promotions, and other incentives.
Compensation, Perks, and Benefits
At Centene, we offer a comprehensive compensation package, including:
- Competitive salary: A competitive salary, with a pay range of $18.66 – $31.73 per hour.
- Benefits: A range of employee benefits, including health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off, and holidays.
- Flexible working arrangements: Flexible working arrangements, including remote, hybrid, field, or office work schedules.
- Opportunities for growth: Opportunities for career growth and development, including promotions, lateral moves, and special projects.
Conclusion
If you are a motivated and experienced eligibility professional, looking for a new challenge and opportunity to grow, we encourage you to apply for this exciting role. As an Eligibility Representative III, you will be part of a dynamic and supportive team, with a strong focus on teamwork, diversity, and inclusion. With a comprehensive compensation package, flexible working arrangements, and opportunities for growth and development, this is an opportunity not to be missed. Apply now and take the first step towards a rewarding and challenging career with Centene.
