Former Employee Enrollment Specialist

Former Employee Enrollment Specialist

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose : The Former Employee Enrollment Specialist is responsible for ensuring the accurate processing of enrollment forms, change forms, termination forms, and other assigned correspondence. This role involves adherence to unit procedures and EGID rules and regulations, managing daily mail productivity, and maintaining compliance with CMS and HIPAA regulations. The specialist also oversees the accuracy of feedback files, low-income subsidy reports, and recurring large and small tasks processing.

Principle Activities May Include :

• Process all enrollment, change, and termination forms within five working days, maintaining established ranges of accuracy and productivity.
• Generate and mail COBRA packets and billing statements in addition to processing enrollments within the required Department of Labor timeframes.
• Process feedback files and low-income subsidy reports within specified accuracy ranges while adhering to CMS PDP Guidance.
• Protect privacy and confidentiality of program participants' information and comply with HIPAA regulations.
• Recognize and deny forms / requests that are considered to be non-compliant within the required accuracy ranges. When necessary, create internal Workflows to address a form / request at a future date. Produce response letters for all non-compliant forms / requests that adhere to all CMS PDP guidance, federal guidelines, and EGID rules.
• Process recurring large reports and queries within the required accuracy ranges and adhering to all CMS PDP guidance, federal guidelines, and EGID rules.
• Process monthly assignments as well as small reports and queries within the required accuracy ranges and adhering to all CMS PDP guidance, federal guidelines, and EGID rules.
• Create and mail letters regarding Pre-Medicare and Medicare enrollments, changes, disenrollments, cancellations or changes within the required accuracy ranges and adhering to all CMS PDP guidance, federal guidelines, and EGID rules.
• Complete special projects as assigned. Respond accurately to inquiries within established timeframes.
• Attend recurring unit / department / division / agency meetings and any mandatory trainings provided by Member Accounts leadership or Human Resources.
• Other duties as assigned.

Knowledge, Skills, Abilities and Competencies The key Knowledge, Skills, and Abilities (KSAs) for the Former Employee Enrollment Specialist position include a solid understanding of CMS PDP guidance, COBRA, and HIPAA regulations, proficiency in processing forms and reports accurately, and strong organizational and problem-solving skills to meet deadlines and ensure compliance. Effective communication and customer service skills are also critical. The Korn Ferry competencies that best align with this role are Decision Quality, which relates to the ability to make sound decisions while processing complex forms, and Ensures Accountability, focusing on adherence to compliance and meeting productivity standards.

Education and / or Experience : A bachelor's degree and 1 year of experience in the health insurance industry in areas such as benefits analysis, claims review or analysis, or medical / dental review or report preparation; OR An equivalent combination of education and experience, substituting 1 year of qualifying experience for each year of the required degree.

Preference may be given to candidates with : A bachelor's degree; OR Two years of experience in bookkeeping work, insurance eligibility determination or closely related work; OR Two years of experience in the maintenance, analysis, and reconciliation of insurance or benefits accounts; OR An equivalent combination of education and experience.

Physical Demands : Must be able to remain sitting for prolonged periods at a desk and working on a computer. Must be able to move or lift up to 15 pounds at various times.

Work Environment : The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines.

Why You'll Love Working Here At the Oklahoma Health Care Authority (OHCA), we're proud to create a workplace where employees thrive. Named a Top Workplace in Oklahoma for five consecutive years, this achievement reflects the dedication and collaborative spirit of our incredible team. Here's what we offer to support employees and their family :

Accommodation Statement : The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and / or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.