Eligibility & Retention Specialist

The Eligibility and Retention Specialist is responsible for making telephone calls to current HomeFirst and Elderplan members with the intent to educate them on Elderplan's Medicaid Advantage Plus Plan benefits. The position focuses on member retention by proactively addressing dissatisfaction for the members at risk for disenrollments. Tasks include verifying plan eligibility, in-network status of the member's current providers, and documenting and capturing activities accurately to ensure the integrity of the process. The position requires excellent communication and organizational skills to facilitate superior coordination between members, Sales Operations, Business Enrollment, Member Operations, Care Management, Assessment Nurses, and the providers. The Specialist will ensure adherence to Medicare and Medicaid guidelines and internal policies.

• Call to existing Homefirst and Elderplan members to introduce Elderplan MAP benefits

• Verifying members' providers participate in the Elderplan network
• Processing MAP referrals for members that agree to enroll

• Documenting MAP introduction and referral outcomes

• Responsible for supporting member retention efforts by identifying and addressing factors that may lead to disenrollment within the HomeFirst and Elderplan MAP lines of business.
• Analyze the weekly Out of Service Area report to track members pending disenrollment for the upcoming month and confirm their return status to determine retention opportunities.
• Participate in all mandatory and ad hoc Coordinated Care team meetings