Anticipated End Date:

2024-10-11

Position Title:

Membership Representative - Bilingual (English / Spanish) Hybrid

Job Description:

Position Title: Membership Representative - Bilingual (English / Spanish) (Hybrid)

Location: Hybrid (Candidates must live within commutable distance of San Juan, PR, Pulse Point: 654 Avenue Luis Munoz Rivera, San Juan, 00927)

A proud member of the Elevance Health family of companies, Carelon Global Solutions, formerly Legato Health Technologies is a managed service delivery organization, providing information technology and business operations services for health plans. 

Build the possibilities. Make an extraordinary impact!

The Membership Representative will be responsible for enrollment and billing activities of assigned accounts.  Respond to incoming/outgoing calls and providing customer service to plan members, providers, and employer groups by answering benefit questions, resolving issues, and educating callers. 

How you will make an impact:

•    Verifies enrollment status, makes changes to records, research, and resolves enrollment system rejections; addresses a variety of enrollment questions and/or concerns received by phone or mail. 
•    Ensures accuracy and timeliness of the membership and billing function. 
•    Responds to inquiries concerning enrollment processes. 
•    Maintains enrollment database and order identification cards. 
•    Determines eligibility and applies contract language for each case assigned. 
•    Performs error output resolution for electronic eligibility and processes error discrepancy list. 
•    Bills, collects premiums, and reconciles payments. 
•    Maintains and reconciles premium bill, self-bill, and individual billed accounts. 
•    Notifies clients of premium discrepancies through payment adjustment notices and detailed audits. 
•    Screens all forms and data for all paperwork received for new group and/or group re-classing benefits. 
•    Screens group for benefits to determine if existing or new, recognizing when benefits are not standard and handling as appropriate. 
•    Documents inquiry outcomes for accurate tracking and analysis. 
•    Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. 
•    Performs basic job functions with help from co-workers, specialists, and managers on non-basic issues. 
•    To perform the tasks outlined above, ability to gain access to the Medicare Advantage Prescription Drug (MARx) system or similar system will be required.

Minimum Requirements:
Requires a HS diploma or GED and related experience; or any combination of education and experience which would provide an equivalent background.  

Preferred Skills, Capabilities & Experience:

• Prior experience with MARx or similar system preferred.

• Bilingual (English / Spanish) or multi-language skills preferred. Must be able to pass a validated language test / assessment.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

MBR > Membership & Enrollment Rep

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.