The individual in this position performs specialized functions and activities related to eligibility and enrollment in Missouri Consolidated Health Care Plan (MCHCP).
Essential Job Functions and Responsibilities:(This list is neither all-inclusive, nor restrictive; management reserves the right to further define duties based on operational needs.)
Process enrollment/change/cancellation and plan incentive forms for current employees and retirees including research of required documentation and generates correspondence as necessary, researches internal systems for accuracy, and answers any related questions.
Respond to plan members, employees, payroll/personnel representatives, MCHCP vendors, government entities, and internal staff regarding billing, eligibility, and other related topics.
Verify member status inquiries on various topics such as leave of absence, worker’s compensation, Family Medical Leave Act (FMLA), disability, terminations, and retirement.
Provide outreach to members, employees, Human Resources and payroll/personnel representatives requesting or verifying information.
Assist with public entity group and state member in the following areas:
Enrollment, eligibility, billing, Consolidated Omnibus Budget Reconciliation Act (COBRA) enrollment, refunds, cancellations, changes, transfers, retirement and Medicare eligibility.
Research and respond to internal department inquiries regarding appeals and process approved appeals.
Assist with communication of medical, dental, vision, Strive for Wellness, and State Employee Life and Family (SELF) program benefits to members.
Process address changes and follow up with any related questions, research and documentation.
Process out of balance reports for active, retiree, leave, and terminated employees. Keys additional deductions for amounts due and/or directly bill for premiums. Apply payments to member’s accounts.
Process and respond to Medicare and Medicaid eligibility inquiries when received from outside sources. Includes working reports for the Medicare Prescription Drug Plan (PDP) and eligibility/enrollment.
Process, generate and distribute state and public entity member COBRA letters and Certificates of Coverage (COC) documentation.
Process deceased member notifications and survivor member enrollment.
Sort and index documents in OnBase.
Assist MCHCP call center during peak times.
Back up front desk receptionist as needed.
Perform other related duties as needed or assigned.
Required Knowledge, Skills and Abilities:
Knowledge of general office procedures and knowledge of proper telephone etiquette.
General knowledge of Microsoft Office including Word, Excel and Outlook.
Ability to perform activities with speed and accuracy.
Ability to quickly learn internal systems such as CORE, On Base, Travis and Genelco.
Ability to operate a computer and computer keyboard and have excellent manual dexterity in order to log summary of telephone conversation using internal software programs.
Ability to follow detailed guidelines and procedures.
Ability to take oral and written directions and then use independent judgment in accomplishing the required task.
Ability to successfully complete Member Services Department training and utilize MCHCP software.
Ability to serve as a productive team member and the ability to demonstrate a professional and positive attitude while establishing and maintaining excellent working relationships with MCHCP management and staff; plan members; plan account managers; and the general public.
Ability to maintain confidentiality of all MCHCP information and records in accordance with Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws and regulations.
Ability to make independent decisions in accordance with established policies and procedures; and ability to prioritize, organize, and perform work independently and under pressure.
Ability to project a professional image through performance, communication and appearance.
Requires a high school diploma or equivalent.
Possess at least 1 or more years of relevant office work experience and general knowledge of insurance and medical terminology. Prefer some formal education beyond high school.
Must be able to type a minimum of 40 words per minute.
Must maintain an excellent attendance record.
Location/Region: Jefferson City, MO