The main duty of a Medicare Enrollment Specialist is to process the members’ enrollment-related transactions from various data sources. A well-drafted Medicare Enrollment Specialist Resume indicates the following duties and responsibilities – researching and resolving member issues; maintaining data within various tracking tools, handling questions and issues and providing detailed information about processes; collecting needed information from patients; entering and updating data on records; providing guidance and recommendations, and assisting with billing and payment processing.
To secure this job, the specialist may require the help of the following skills – strong attention to details; multitasking skills; proficiency with relevant software; high level of accuracy, excellent administrative skills; knowledge of database and relevant software programs; and experience in the relevant field. A degree is commonly seen on eligible resumes.
Headline : Honest, dependable, detail-oriented, highly skilled, and seasoned customer service professional who works well under pressure and seeks new challenges for educational and personal growth. Customer service professional with more than nine years of experience in the TRICARE health care insurance industry.
Skills : Process Enrollments, Research, And Resolve Claims, Authorization Issues.
Description :
Provided exceptional customer service to our members.
Provided benefit education regarding eligibility, and services.
Processed Medicare and Medicaid enrollments and disenrollments in accordance with guidelines.
Received and worked with incoming eligibility from a variety of sources to include paper, tape, or internet enrollment applications.
Entered information during the enrollment process that assists claims personnel in claims adjudication including COB.
Maintained detailed tracking of each function within the enrollment and dis enrollment process including correspondence and the issuance and accuracy of member ID cards.
Assisted in getting the company through its open enrollment period.
Experience
5-7 Years
Level
Executive
Education
Certificate In Medical Reception
Medicare Enrollment Specialist Resume
Summary : Seeking a Medicare Enrollment Specialist position with an organization where my extensive experience in customer service will be further developed and utilized to secure a position where can grow and develop.
Skills : Medical Terminology, Customer Service, Management, Microsoft Office, Medical Billing, Medical Records, Leadership Development.
Description :
Performed general office duties, such as typing and operating office machines.
Sorted or classified information according to content, purpose, and user criteria.
Determined how and where information should be filed.
Demonstrated strong attention to detail.
Displayed excellent customer service skills.
Communicated verbally and in writing with members, CMS, physicians, MedImpact, third parties, and other departments as required to facilitate the enrollment and disenrollment processes.
Processed and reconciled Medicare eligibility and enrollment information, with emphasis on escalated issues for management.
Experience
7-10 Years
Level
Management
Education
BS In Management
Medicare Enrollment Specialist Resume
Summary : Motivated, personable business professional and multiple star award recipient with a successful 9-year track record of exceptional participation in process improvement. Talent for quickly mastering technology and being an innovative thinker. Demonstrated history of producing accurate and timely reports while meeting all CMS contractual obligations and deadlines.
Skills : Organizational, leadership, Communication, Process Improvement, Analytical, Problem-solving.
Description :
Entered member information including initial enrollment, changes, additions, and deletions on all groups.
Created accurate and timely documentation of all changes or inquiries made to a member's account information.
Requested and assigned PCP's to members who have not chosen one.
Processed provider changes as requested.
Performed eligibility verification on members.
Maintained a follow-up file where additional information has been requested by members.
Maintained membership reporting requirements on all member groups and provider groups.
Experience
7-10 Years
Level
Management
Education
BS In Insurance Forms
Medicare Enrollment Specialist Resume
Summary : Professional and organized Skilled in sales, billing, collections, customer enrollment, and insurance verification Experienced in developing and maintaining relationships with customers and organizations. Articulate in communicating company policies and procedures. Proficient in Microsoft office databases and various company-specific databases.
Skills : Medical Office, Problem-solving skills, Computer skills, Medical Terminology.
Description :
Collected & analyzed members' information pertaining to the member's application and claims.
Identified research and documented all facts concerning member's case management. Drove the consumer engagement and loyalty on a one on one basis.
Ensured compliance with all Federal Medicare statutes and policies.
Developed and managed procedures and systems to respond to issues to a successful resolution for members while maintaining Humana core values.
Managed self and built relationships effectively to produce a productively work environment.
Able to achieve results and take the initiative to help others.
Composed letters, make phone calls, and additional correspondences.
Experience
7-10 Years
Level
Management
Education
Bachelor Of Science
Medicare Enrollment Specialist Resume
Summary : Creative, versatile professional with a positive attitude and great at project management. Flexible with strong problem-solving skills in a fast-paced, ever-changing environment. Experience includes working with a large age range with proven leadership, training, and organizational skills while maintaining brand standards and interpersonal relationships.
Skills : Creative Skills, Problem Solving Skills, Effective Communication Skills, Medicare.
Description :
Responsible for handling all customer service inquiries through multiple channels.
Responsible for effectively presenting and discussed products and services
Created and maintained positive relationships and for exceeded quality and productivity goals
Assisted members with their questions about benefits, health/insurance coverage, co-pay, billing, etc. in regards to their medical information.
Managed a structured onboarding agent process, leveraging corporate contracting, certification, and training processes, tools, and systems. This includes contracting, licensing/appointment, certification, training, enrollment administration, commission payment, agent servicing, and compliance.
Provided oversight for maintaining a License Management Reporting System that keeps track of the Agents' acquired state licenses, Carrier and Plan Sponsor appointments, and any upcoming license renewals.
Worked closely with Legal to ensure broker contract terms & conditions to meet business and compliance needs.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Science
Medicare Enrollment Specialist Resume
Summary : Highly motivated and formally trained customer service professional/manager with demonstrated ability to exceed performance goals, improve customer satisfaction levels, solve problems, and build lasting relationships. Strong in training staff, and following up with their progress, as well as helping them obtain success in their current position.
Entered members/clients into the prescription drug system and also into the insurance benefits system.
Spoke with members/clients on an as-needed basis to verify information on applications.
Spoke with office managers to obtain information needed for physician credentialing.
Assigned, verified, and processed the group data.
Entered members/clients into the prescription drug system and also into the insurance benefits system.
Provided general information about Humana's products, value, and rates to prospective customers over the telephone.
Met and consistently exceeded sales and activity goals established for individual representatives and teams.
Experience
10+ Years
Level
Senior
Education
Certification in Insurance Forms
Medicare Enrollment Specialist Resume
Summary : Over 10 years' experience in Medicare Enrollment Specialist benefit eligibility, member services, Medicare/ Medicaid and commercial health plans, specialty pharmacy PBM, hospitality, and retail call center environments. Extensive training in customer service, health insurance benefits, Medicare enrollments, medical and RX claims, quality assurance, and contract processing.
Skills : Medicare HMO, Specialty Pharmacy, Health Insurance, Customer Service Call Center, Healthcare, Data Entry.
Description :
Processed new member enrollment applications, plan changes, cancellations, and disenrollment.
Provided Customer service inbound/outbound calls from members regarding eligibility, verification of enrollment status, PCP changes, Address & Tel changes, COB updates, prior auth, RX statuses, EOB such as deductibles, copayments, and tier drug info.
Contacted members to obtain missing information per Medicare chapter 2 requirements.
Reconciled eligibility discrepancies, analyze transactional data, and submit eligibility changes.
Maintained hard copy and electronic filing system.
Collected and maintained various enrollment reports such as Oversight reports, TRR, late enrollment penalty, Medicaid recertification, LIS-levels, use of SQL to run queries for daily reports Receiving of all mail and distribution to designated team members.
Assisted members with post-enrollment maintenance of their Medicare plans by reviewing whether or not they had creditable coverage.
Experience
7-10 Years
Level
Management
Education
High School Diploma
Medicare Enrollment Specialist Resume
Objective : Highly motivated and dedicated individual, seeking a great job opportunity where I demonstrate my professional skills acquired through proficient training and education.
Skills : Medical Terminology Customer, Writing Skills, Organizational Skills.
Description :
Provided general information and services to clients.
Received award for most productive team members. Provided excellent customer service by assisting clients with their Medicare applications Edit.
Connected with consumers and delivered an exceptional e-commerce experience during the interaction
Handled various incoming sales-focused phone calls and assisted the consumer in comparing and buying the best product
Resolved customer questions, complaints, and inquiries in a professional, helpful manner
Promoted client products and serviced by emphasizing product features aligned to the consumer's needs
Utilized computer systems and online tools to verify and documented consumer applications.
Experience
2-5 Years
Level
Junior
Education
Certified In Medical Office
Medicare Enrollment Specialist Resume
Summary : Over 3+ years of experience in working in a health payer Medicare practice. Work directly with the team working to deliver an industry-leading Medicare Enterprise Platform that handles end-to-end aspects of a health insurance payer's Federal and State lines of business.
Skills : MS Office, Customer Service Skills, Verbal Skills.
Description :
Responded to internal and external customer inquiries regarding eligibility, benefits, authorizations, complaints, and related functions.
Uploaded state and CMS files and process and reconcile enrollment or eligibility discrepancies.
Performed Audits and fix enrollment data errors and member information.
Entered information during the enrollment process that assisted claims personnel in claims adjudication including COB.
Received and worked with incoming eligibility from a variety of sources.
Used an online call tracking system to document all activities and communication from members, providers, and other customers.
Continually improved knowledge of company services and products.
Experience
7-10 Years
Level
Management
Education
BS In Billing & Coding
Medicare Enrollment Specialist Resume
Headline : Friendly and enthusiastic Medicare Enrollment Specialist with 7 years of specialization in Medicare and General Customer Service. Able to learn new tasks quickly and proficient in growing key customer relationships. Represent establishment with friendly, professional demeanor at all times.
Skills : Medical Technology, Medicare, Communication Skills.
Description :
Used computers for various applications, such as database management or word processing.
Created, maintained, and entered information into databases.
Completed forms in accordance with company procedures.
Located and attached appropriate files to incoming correspondence requiring replies.
Escalated calls to supervisor when necessary and appropriate
Provided feedback reports on call issues related to downtime and/or training issues.
Able to work autonomously and produced standard documentation that can be used for product development, solution delivery, and sales activities.
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