Analyst, Enrollment

Job Summary

Responsible for preparation, processing, and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials. Provide customer service to plan members, providers, and employer groups by answering benefit questions, resolving issues, and educating callers. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via mail, phone, or email. Maintain records in the enrollment database.

Knowledge / Skills / Abilities

Manages the daily process of member exceptions from state eligibility file and takes appropriate action to ensure members are properly enrolled. Tracks and follows up on any exceptions with revenue amounts expected from the State and maximizes recovery. Researches discrepancies from state payments in order to ensure accurate payment to the health plan. Compiles and reviews all reports, historical trends, and forecasts future enrollment activities. Manages and prepares daily performance reports summarizing key performance indicators regarding enrollment statistics. Facilitating and coordination of meeting materials with Health Plan Compliance and Operations VPs for multiple states. Subject Matter Expert in E2E enrollment processes for multiple states. Assist with projects as assigned by Director, Enrollment concerning trending analysis, inventory, or other enrollment-related areas. Quality review and submission of deliverables to Molina Healthcare Government Contract and to State Medicaid Agencies. Tracking all contractual related tasks to completion. Monitor inventory analysis provided by third party vendor for accuracy and explanation. Record and publish enrollment events on SharePoint that are available for department and third-party vendor use. Assist manager with preparation of submission of Sarbanes-Oxley (SOX) audit data to internal and external auditors. Assist with complex enrollment issues concerning member eligibility.

Job Qualifications

Required Education : Associate's Degree or equivalent combination of education and experience. Required Experience : 1-3 years. Preferred Education : Bachelor's degree in Accounting and / or Business or equivalent experience. Preferred Experience : 3-5 years.