Fallon Health

  • Commercial Enrollment Representative - Growing Health Care Org!

    Location US-MA-Worcester
    Posted Date 7 months ago(10/17/2017 3:01 PM)
    Job ID
    # Positions
    Enrollment & Billing
  • Overview

    About Fallon Health:

    Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.


    Position Overview:

    Under the direction of the Supervisor or Manager, the Enrollment Operations Representative supports Fallon Health’s mission, vision and values by providing and maintaining timely and accurate enrollment information. He/She documents pertinent information enabling tracking of group/subscriber/member and eligibility and adheres to internal and external SLA’s. Also refers concerns appropriately when escalation is required and follows through to closure of issues.

    The Enrollment Operations Representative collaborates effectively with co-workers and other departments to ensure quality service to our internal and external customers.  He/she maintains a positive approach to issues and concerns as they arise, and works to identify and recommend process improvements to his/her direct supervisor.

    Handles confidential group/subscriber/member information. Maintains current understanding of policies and procedures; initiates self-development via available company and industry educational opportunities. Demonstrates a desire and ability to thrive in a collaborative, fast-paced environment

    Pre-requisites for success in this position include: Strong verbal & written communication skills including demonstrated excellence in telephone communication skills; strong organizational skills, computer skills. Handles confidential patient/member information. Knowledge of Plan policies, protocols, and procedures. Requires ability to work in a fast-paced environment with multi-disciplined staff. Consistent follow through on issue resolution and strong multitasking abilities are essential along with taking accountability and understanding job functions can change based upon the business need. Tier I representative would be responsible for enrollment maintenance, adhering to the phone schedule and administrative related tasks



    • Provide knowledgeable response to internal and external customer inquiries and concerns regarding enrollment including, but not limited to, qualifying events, enrollment policies and procedures, ID cards, selection of primary care physician and enrollment maintenance.
    • Reconcile membership/billing reports with employer group or intermediary data to ensure accuracy of information. Communicate professionally to resolve discrepancies.
    • Provide all necessary eligibility support to the Sales department, as needed.
    • Maintain current inventory and timely closure of all assigned issues and workload.
    • Process all transactions related to subscriber/member data in a timely and accurate manner. Escalate inventory backlog daily.
    • Display initiative to assist Supervisor in balancing workload with co-workers as the flow of work varies.
    • Maintain active and consistent availability on the phone system, as scheduled.
    • Partner with other Operations departments to maximize the efficiency of shared work.
    • Meet deadlines with accuracy
    • Prioritize daily and weekly work
    • Resolve/Escalate issues in a timely manner
    • Participate in departmental and company-wide process improvement projects, training, testing and team meetings as assigned.

    • Perform other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks.

    • Working department returned Mail

    • QC



    Education: High School diploma required; Bachelor’s Degree preferred

    License: none

    Certification: none


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