Department(s): Customer Service
Reports to: Supervisor, Member Enrollment
FLSA status: Non-Exempt
Salary Grade: C – $19.7115 – $25.4808 ($41,000 – $53,000)
Job Summary
The Program Assistant (Enrollment Medicare) will assist with the specialized services for Medicare dual eligible members including data reporting, analysis, and reconciliation. The incumbent must have a strong focus around member retention through accurate and timely resolution of issues and functions with minimal direction and will need to prioritize daily tasks and work items in queue, manage turnaround times, and manage items that require escalation. The incumbent will partner cross-functionally with various operational business units while supporting departmental objectives within the company and regulatory guidelines. In addition, the incumbent will be responsible for complex and escalated enrollment and disenrollment tasks.
Position Responsibilities:
Coordinates specialized processes for the program.
Answers all questions and interprets policies and regulations.
Develops materials; prepares and coordinates data for reports.
Ensures processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures, and policies..
Represents the program on projects or as a liaison within or outside CalOptima.
Facilitates communication on specialized topics.
Prepares reports and creates reporting tools
Acts as liaison between Enrollment and other Customer Service staff.
Conducts quality assurance audits.
Other projects and duties as assigned by management.
Possesses the Ability To:
Provide professional support to managers and staff within the department.
Communicate clearly and concisely, both verbally and in writing.
Coordinate work of specialized processes or functions with staff in the department and other departments within CalOptima, as well as members or providers.
Collect data, identify pertinent information, and prepare reports and presentations.
Conduct presentations and provide information about the CalOptima program in a concise and professional manner.
Establish and maintain effective working relationships with CalOptima leadership and staff.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education
High School diploma or equivalent required.
1 year of experience in eligibility and/or reconciliation is required.
Preferred Qualifications
Health insurance background (Medi-Care) as well as previous experience interacting with regulatory agencies, including Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC) and practices related to Medi-Care is also preferred.
Bilingual in one of CalOptima’s defined threshold languages (Spanish, Vietnamese, Arabic, Farsi, Korean, Chinese) is preferred.
Knowledge of:
Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes.
Services, policies, and general responsibilities of the program.
Practices and techniques required to function with professionals working in the department.
Methods and techniques for organizing and implementing processes.
General information relevant to professional or administrative responsibilities in the department.
Community resources (SSA/Department of Health Care Services).
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3521
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