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Blue Cross Blue Shield of Massachusetts Enrollment Processor III, Medicare Operations l Health Care in Hingham, Massachusetts

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The Enrollment Processor III is responsible for timely enrollment of new member applications into internal eligibility systems and changes. Demonstrates competency in all aspects of the enrollment process and will become proficient in Medicare Advantage (CMS) and Medex (DOI) regulations. The Enrollment Processor is responsible for processing enrollment transactions accurately and in compliance with the Center for Medicare and Medicaid Services. Utilize strong research skills to identify and resolve member escalated issues.

Key Accountabilities:

  • Download and process enrollment files and paper applications, ensure applications are processed accurately and timely

  • Contact members telephonically to obtain any missing information to complete their enrollment applications

  • Update member records; including address changes, bill option changes and plan changes

  • Analyze enrollment error reports, identify trends and report to leadership

  • Process enrollment queues in the membership system; ensure data integrity across all systems

  • Create and maintain enrollment processing policies and procedures and workflows

  • Cross train to support: Process Control and assist during vacancies and high inventory periods, LEP review and submission, work items and applications, and other functions as identified

  • Contribute toward achieving Medicare Markets goals including STARS, SQM and CAHPS and demonstrate complete, accurate and timely enrollment processing

  • Perform daily review of our vendor letters to ensure letters are accurate and appropriate

  • Provide outstanding level of service to both internal and external customers by supporting the MAPD Enrollment Helpdesk to help achieve first call resolution

  • Work on various projects relating to Medex and Medicare Advantage such as audits and monthly reporting

  • Help to resolve Medex pending applications to complete member enrollment applications

  • Other responsibilities as identified by Leaders

  • Work well in a team environment and keep communication lines open with leaders and peers

Qualifications (Knowledge, skills, and abilities):

  • Strong written and verbal communication skills

  • Ability to work closely/successfully in a team environment

  • Ability to work additional hours during peak inventory periods (during Open Enrollment from October – March)

  • Demonstrate flexibility and willingness to be cross trained to support other job functions to ensure business unit success

  • Excellent time management and organizational skills; strong attention to detail

  • Ability to work in fast-paced, deadline-driven dynamic environment

  • High degree of initiative; decision-making skills

  • Knowledge of customer service environment, including BSC, TPS, RTMS, and NASCO preferred

Education/Relevant Experience:

  • Bachelor’s degree or equivalent work experience preferred.

LocationHinghamTime TypeFull time

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

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