X - As-Needed / TEMP - Program Assistant, Enrollment - Covered California
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Position Information:
Submission Information:
Duties & Responsibilities:
95% - Program Support
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Coordinates specialized processes, including eligibility analysis, strategic provider assignments, age restriction and complex condition member administration/monitoring and floor audits for the Medi-Cal program.
Assists with completing various members requests, such as Change of Health Network Requests, primary care provider (PCP) change requests and data correction forms.
Responds to questions and interprets policies and regulations.
Prepares materials (e.g., letters/surveys, etc.) and coordinates data files to arrange for mail merge of materials as applicable.
Assists with ensuring processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures and policies.
Represents the Medi-Cal program on projects or as a liaison within or outside CalOptima Health.
Facilitates communication on specialized topics.
Prepares reports and creates reporting tools; performs special reconciliation procedures, including Excel sorts and mergers, filters and compiling reports and Access database procedures.
Acts as liaison between the Enrollment department and other Customer Service staff.
Supports with quality assurance audits to validate the accuracy of Protected Health Information / Appointment of Representative (PHI/AOR) and Acceptance Letter updates processed by other staff members.
Conducts outreach to members for various Enrollment department reasons.
Conducts outreach to health insurance carriers to verify potential Other Health Coverage (OHC).
Assists with processing mailed-in member surveys submitted by manually updating members'' profiles with various updates, including demographic changes, other health coverage, and address changes.
Responsible for opening, sorting, reviewing, and tracking of returned mail by maintaining an organized and accurate log to ensure timely submission for monthly text campaigns.
5% - Completes other projects and duties as assigned.
Minimum Qualifications:
Preferred Qualifications:
Health insurance experience (Medi-Cal).
Prior experience interacting with regulatory agencies, including Department Health Care Services (DHCS) and
Department of Managed Health Care (DMHC) and practices related to Medi-Cal.
Experience in a Health Maintenance Organization (HMO), managed care or Medi-Cal setting.
Customer Service experience.
Bilingual in English and in one of CalOptima Health''s defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
Required Licensure / Certifications:
Knowledge & Abilities:
Physical Requirements (With or Without Accommodations):
Work Environment:
If located at the 500, 505 Building or a remote work location:
If located at PACE:
If located in the Community:
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
| Location | Orange, CA |
| Salary | $49,754–$69,655 Per Year |
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