Qureos Mentor

Temporary Professional Integrated Services

<div><div><div><div><p>Analyzing and determining the prospect eligible for the Medicare Advantage Programs.</p><p><b>
Responsabilities:</b></p><ul><li>
Receives and processes applications for Enrollment, unsubscribe, Cancellation, and Product Changes received in the Eligibility Unit within 7 days.</li><li>
Evaluates, analyze, and determines that enrollment documents submitted by Sales Representatives and Independent Agents comply with established state, federal, and business regulations.</li><li>
Determines prospect eligibility in CMS and Ases systems, performs data entry or correction in Voyager and On Base systems, determines applicable eligibility period, makes notes, and sends appropriate letters.</li><li>
Identifies cases that cannot be processed due to missing information, which initiates the returns process. This process includes documentation in the system of the reason for return, notification by letter to the prospect, and internal notification to the sales areas.</li><li>
Generates weekly reports of all cases in the system awaiting information, ensuring final determination does not exceed the applicable 7 or 21 days, to comply with current federal regulations.</li><li>
Works the weekly audit report to ensure that no case has been processed or denied without a notification letter. All required letters must be sent within 7-10 days.</li><li>
Complies with the OFA (Out of Area) unsubscribe process, which should be done within the first 3 days of each month. If receives an OFA unsubscribe cancellation request, analyzes, and evaluates if the case meets the necessary criteria to submit the request and generates the applicable letter within 7 days.</li><li>
Monitors analyzes, and documents cases under the LEP (Late Enrollment Penalty) process in the Lep Track and Voyager applications daily.</li><li>
Analyzes cases referred by the Grievance and Appeals Unit related to enrollment and unsubscribe processes. Provides requested information and offers recommendations for action within 24-48 hours.</li><li>
Responsible for receiving, punching, classifying, and digitizing all internal and external correspondence received in the Affiliations Unit.</li><li>
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.</li></ul><p><b>
Requirements:</b></p><ul><li><b>
Education and experience: </b>60 university credits or equivalent to two (2) years of studies or associate degree in Business Administration or Health Services Billing preferably. Minimum of one (1) year of experience in group and individual enrollment processes, preferably in the Health Insurance Industry.</li></ul><p>
Monday to Friday</p><p>
8am-5pm</p></div></div><div><p>
Job Type: Full-time</p></div><div><p>
Salary: $13.00 per hour</p></div><div><p>
Physical setting:</p><ul><li>
Office</li></ul><p>
Schedule:</p><ul><li>
8 hour shift</li><li>
Monday to Friday</li></ul></div></div></div>

PR-ENROLLMENT AND ELIGIBILITY ANALYST

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Temporary Professional Integrated Services

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PR-ENROLLMENT AND ELIGIBILITY ANALYST