Enrollment Eligiblity Representative - Irvine, CA

Position Description:

Energize your career with one of health care's fastest growing companies.  

You
dream of a great career with a great company where you can make an
impact and help people. We dream of giving you the opportunity to do
just this. And with the incredible growth of our business, it's a dream
that definitely can come true. Already one of the world's leading health
care companies, UnitedHealth Group is restlessly pursuing new ways to
operate our service centers, improve our service levels and help people
lead healthier lives.  We live for the opportunity to make a difference
and right now, we are living it up.

This opportunity is with one
of our most exciting business areas: Optum a growing part of our family
of companies that make UnitedHealth Group a Fortune 17 leader.

Optum
helps nearly 60 million Americans live their lives to the fullest by
educating them about their symptoms, conditions and treatments; helping
them to navigate the system, finance their health care needs and stay on
track with their health goals. No other business touches so many lives
in such a positive way. And we do it all with every action focused on
our shared values of Integrity, Compassion, Relationships, Innovation
& Performance.

Primary Responsibilities:

• Researching
  errors by comparing enrollment error reports against system information
  along  with CMS (Center for Medicare and Medicaid Services) records.
• Sending
  correspondence to members or CMS (Center for Medicare and Medicaid
  Services) to gather information or provide updates for corrections.
• Reconciling reports
• Performing basic clerical functions with proficient PC skills
• Analytical and Researching techniques to trend or quantify projects
• Initiate and assist with developments/ changes to increase or change quality and productivity
• Preparing, processing, and maintaining new member or group enrollments
• Responding to member eligibility or group questions & verify enrollment status
• Working with various types of member correspondence
• Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes
• Inventory control of member and group transactions
• Conduct audits and provides feedback to reduce errors and improve processes and performance
• Acts as a liaison between the client management and development teams
• Process and troubleshoot batch eligibility files
• Verify distribution of all necessary outbound reports
• Coordinate eligibility set-up for new clients and assist with client requested changes
• Verify and research information in response to customer inquiry
• Proactively responding to member eligibility or group questions & verify enrollment status
• Participates in creating process documentation
• Adhere to all key audit controls and comply with all established standards associated with HIPAA, SOX, and SAS70