Become a part of our caring community and help us put health first
 

Humana/iCare is seeking a Lead Enrollment Representative who will act as the lead for all iCare enrollment processing. Primary responsibilities include functioning as the lead Enrollment processor for all lines of business including Medicare, Medicaid, Badger Care Plus and Family Care Partnership (FCP). Other functions include maintenance of the iCare eligibility information for members in these plans, working with Finance on encounter data reports, monitoring the daily workflow of the department, audit conference participation, and oversight of the iCare enrollment staff.

• Process enrollments, disenrollments and various eligibility changes from the 834 files for Medicaid and Badger Care Plus.
• Enter Family Care Partnership (FCP) enrollments into the Enrollment ODS and interact with FCP staff members, the Wisconsin Department of Health Services (DHS), Centers for Medicare and Medicaid (CMS) and other external resources as needed.
• Process the Medicare enrollments timely and forward the Medicare enrollments to Cognizant including the downloading and processing of the CMS TRR.
• Perform quality checks on various enrollment transactions completed monthly including weekly audits/verification of Medicare enrollments.
• Assist in the configuration and maintenance of Medicare Enrollment Model Letters to ensure compliant documentation is in use.
• Work with Finance in processing and reconciling member share and premium rate discrepancies for all lines of business and their encounter data. 
• Identify, research, and resolve eligibility inquiries and issues with CMS, Cognizant, iCare staff and other related parties.
• Assist in resolution of provider/enrollee complaints or appeals that relate to eligibility problems.
• Coordinate and perform COB validations including daily inquiries from various iCare departments, as well as monthly files received from DHS/CMS.
• Participate in internal and external audits by assisting in the preparation, providing documentation, and explaining the Enrollment Department’s processes to auditors as needed.
• Provide training to enrollment staff.

Use your skills to make an impact
 

Required Qualifications

• Minimum of three (3) years of experience in the medical insurance, Medicaid and/or Medicare managed care insurance environment working with eligibility/enrollment information and resolution of enrollment issues.
• 2 or more years of experience with Medicaid Forward Health and/or Medicare CMS eligibility information systems and understanding of Medicaid and Medicare eligibility terms and processes.
• Hands-on PC experience to include experience in data entry, word processing and spreadsheet applications. Demonstrated use of Microsoft Office applications including Excel, Word, and Outlook.
• Previous experience leading a department where you were responsible for overseeing the workflow of others/tasks.
• Must be able to work Monday- Friday, 8:30-5pm CST

Preferred Qualifications

• Reside in the State of WI

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.  
• Typical Work Days/Hours: Monday through Friday; 8:30 am – 5:00 pm Central Standard Time (CST)

WAH Internet

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and ex