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Supervisor, Eligibility - Rancho Cucamonga, United States - Inland Empire Health Plans
Description
What you can expectFind joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an
authentic experience
Under the direction of the Manager of Business Systems Operations, the Supervisor, Eligibility & Payment Services is responsible for managing the daily operations and processes of the Eligibility & Payment Services team, including the delegation of duties, task assignments, and projects to maintain timeliness and inventory.
The primary functions of this position include but are not limited to, identification, research & reconciliation of premium billing payments to ensure appropriate payment allocation, eligibility processing including enrollment, disenrollment corrections and retroactivity, outreach to members to advice on payment delinquency and resolution options for the Covered CA line of business.
The Supervisor acts as a subject matter expert for the business areas by leading the efforts related to Covered CA eligibility and premium billing.
The Supervisor, Eligibility & Payment Services will contribute to the system build efforts, maintain comprehensive documentation of business and technical specification requirements.
The Supervisor will facilitate communication and formally report findings to various department leaders in a manner that is appropriate to the skill level and technical expertise of the audience.
PerksIEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities
Education & Experience
Four (4) years of experience in a managed care setting with at least two (2) years of eligibility research experience required
Four (4) years of Member Data Configuration or experience working with Eligibility data required
Experience demonstrating excellent organizational, time management, facilitation, and negotiation skills required
Experience demonstrating initiative and self-direction with the ability to work well independently and in teams while serving as a Subject Matter Expert (SME) required
Supervisory/lead capacity experience required
Two (2) years of Accounts Receivables (AR) experience preferred
Experience with Covered CA or other Exchange products preferred
Experience with call center operations preferred
Key Qualifications
Knowledge of Medi-Cal and CCA eligibility required
Knowledge of eligibility file processing required
Knowledge of managed care operations required
Knowledge of CCA, DMHC, NCQA rules and regulations preferred
Knowledge of file format including codes and guidelines preferred
Bilingual Spanish/English verbal skills preferred
Ability to navigate enrollment, eligibility, payment/billing, and other backend systems
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