You can make a difference in people’s lives every day. When you join UCLA Health, you’ll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of them plays a vital role in our commitment to care.
As a member of the Medicare Advantage Operations team, the Senior Medicare Advantage Enrollment Representative plays a pivotal role in processing all enrollment, disenrollment, and cancellation requests. This position requires a deep understanding of Medicare Part D programs and meticulous attention to detail to ensure accurate and timely processing. The ideal candidate will possess excellent communication skills and the ability to collaborate with various departments to address member issues promptly and implement ADHOC resolutions to sustain quality member care.
Responsibilities include:
- Ensure accurate completion of enrollments in accordance with CMS and other Managed Care Guidelines
- Process all Enrollment, Disenrollment, cancellation requests, reinstatements and managed retro reconciliation files or requests
- Reconcile daily Transaction Reply Report (TRR) and retro reconciliation files
- Maintain oversight on the accuracy and timeliness of acknowledgment notices sent to members
- Maintain open lines of communication with various departments to resolve member issues promptly and implement ADHOC resolutions to sustain quality member care
- Understand all aspects of enrollment operations, Medicare membership enrollment, reconciliation, and benefits coordination operations
- Hands-on experience with 834 EDI, State (CA DHS), and CMS files
We’re seeking detail-oriented, self-directed professional with:
- High School Diploma or equivalent work experience required
- Required a minimum of three years’ experience in a Medicare health plan or Managed Care – Enrollment, Disenrollment and Reconciliation
- Robust knowledge of Medicare and CMS enrollment and billing regulatory requirements
- Initiative, problem identification, resolution and analytical skills are essential
- Excellent oral and written communication skills are required
- Ability to modify and adapt operational procedures to changing operational needs
- Ability to develop, implement, and evaluate methods and systems to improve efficiency
- Proven skills to lead and facilitate cross-functional workgroups and other meetings
- Ability to work as part of a team, collaborating with colleagues
- Ability to analyze and organize complex federal and private insurance regulations
- Ability to travel/attend off-site meetings and conferences
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VINCENT, Sr. CLS Specialist, Toxicology
MONICA
I've been blessed to touch so many lives through my serving. It's a privilege to uplift other employees with words of encouragement and a smile.
SOZIT
The first thing i noticed when i joined the team was how everyone is very welcoming and friendly with supportive management. I did not feel like an outsider.
EDGAR
Once I joined, I knew UCLA Health was THE place to be due to the growth potential and training offered
RENE
If you want to grow professionally, this is the right place for you.
ERA
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ELIZABETH
It’s so diverse and inclusive here. There’s always the opportunity to share your thoughts. It's a place where you feel you belong.
JERRY
Your career path at UCLA Health will enable you to follow a myriad of avenues and turns. It opens up a wide variety of opportunities.
ORLANDO
There’s a togetherness and higher level of commitment to teamwork at UCLA Health. We are several groups and teams that work together with a common goal which is to improve our patients experience.
DAVID
UCLA Health walks the walk and talks the talk! It's an incredible feeling to work for an organization that always puts the patient first. I am honored to work in full alignment with the UCLA Health Mission and Vision.
DR. ISLA GARRAWAY
UCLA has incredible resources and a team science approach. The ability to work with collaborative teams and access the amazing resources around campus is the best part about being at UCLA.
RADU
UCLA is very diverse in its personnel as well as its many research fields studied
JENNA
UCLA Health provides so many opportunities to exchange ideas, share moments and grow. I have learned a lot about team management and relationship building.
SHARON
I was looking for a job to further my career and continue to improve and learn as a therapist.
TARO
I have been blessed to be surrounded by supportive colleagues who aspire me to be the best version of myself.