Enrollment Analyst

Responsibilities:
Essential Functions:
·Performs extensive review and analysis of enrollment applications submitted to MHIP.
·Researches and resolves enrollment and eligibility issues through analysis and verification of prescribed MHIP acceptance criteria; i.e.:
npotential members are not eligible for group health coverage, COBRA, state assistance or children’s health programs, Medicare or any other government-sponsored health insurance program;
npotential members have exhausted all available group coverage or moved into state from another state’s high-risk pool;
npotential members have, or have been offered, health insurance that provides limited restricted coverage, or that excludes coverage for a specific medical condition or conditions;
npotential member are receiving a federal Trade Readjustment Allowance or unemployment benefits under the Trade Adjustment Assistance program, or receiving pension payments from the Pension Benefit Guaranty Corporation;
npotential members have been refused individual health insurance for medical reasons or have a specified medical condition.
·Authorizes approval of enrollment application and member eligibility.
·Generates letters sent to members explaining the disposition of their applications.
·Communicates information to members in a manner that is consistent and professional.
·Determines member premiums, sends members initial invoices and communicates this information to the finance department..
·Accurately records and updates enrollment and eligibility information in the appropriate databases.
·Maintains above average knowledge base of MHIP policies and procedures and desktop procedures and follows guidelines consistently.
·Communicates effectively with management and follows appropriate chain of command with regard to departmental issues, and member enrollment and eligibility issues.
·Maintains confidentiality of member enrollment information.

Secondary Functions:
·Handles “walk-in” and phone inquiries from members on coverage issues and application assistance.
·Ensures that applications are processed in a timely fashion and in compliance with MHIP standards and regulations.
·Works in a manner that is not disruptive to peers, supervisors and/or subordinates. Maintains professionalism.
·Maintains regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
·Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
·Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs, if required.
·Performs other duties and special projects as assigned.
REQUIREMENTS
Knowledge and Skills:
·Excellent verbal and written communication skills; detailed documentation skills required.
·Excellent analytical and problem-solving skills.
·Strong organizational skills.
·Ability to take complex problems and communicate clear, concise and professional customer responses.
·Ability to perform statistical functions and maintains accurate enrollment records.
·Ability to multi-task in a fast-paced work environment.
·Ability to successfully utilize Microsoft Office software applications and common computer and office hardware.
·Ability to be tactful and to be a team player.

Educations and Experience:
·Bachelor’s degree or equivalent work-related experience within a managed health care or government health care (Medicaid) work environment; enrollment membership and/or insurance underwriting experience preferred.