Receiving and processing new member enrollment information
Verifying eligibility against hhsc contractual requirements
Validating enrollment data and reconciling discrepancies
The Eligibility and Enrollment Specialist is responsible for receiving, reviewing, processing, and maintaining new member enrollment information while ensuring compliance with Health Human Services Commission and URAC standards
Job Summary
The Eligibility and Enrollment Specialist is responsible for receiving, reviewing, processing, and maintaining new member enrollment information while ensuring compliance with Health Human Services Commission and URAC standards.
Employees are expected to maintain the utmost level of confidentiality and adhere to all department policies, procedures, and ethical guidelines.
The role involves responding to member eligibility questions, assisting with PCP assignments, and managing escalations to Maximus and HHSC when required.
Matching Summary
The Eligibility and Enrollment Specialist is responsible for receiving, reviewing, processing, and maintaining new member enrollment information while ensuring compliance with Health Human Services Commission and URAC standards.
Skills & Requirements
Must-have
Receiving and processing new member enrollment information
Verifying eligibility against HHSC contractual requirements
Validating enrollment data and reconciling discrepancies
Maintaining confidentiality and compliance with URAC standards
Generating reports on eligibility trends and changes
Nice-to-have
Strong knowledge of Microsoft Office suite applications
Experience in a managed care environment
Ability to work collaboratively as part of a family team
Ethical business practices and corporate integrity adherence
Key Requirements
Two-year degree or Associate's degree preferred
Minimum one year in eligibility and enrollment environment
Minimum one year Managed Care experience preferred
Strong knowledge of Microsoft Word, Excel, PowerPoint, and Outlook