It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Member Enrollment Representative is responsible for ensuring member data is accurate and up-to-date so members can obtain services from our healthcare providers. The Member Enrollment Specialist maintains many aspects of a member’s file in regards to eligibility, Primary Care Provider (PCP) and demographic information in accordance with the daily files received from the state.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Research and resolve daily materials error report issues.
• Accurately process PCP Routing Queue (requests from Customer Care to update PCPs) daily.
• Process Claims Routing Queue to ensure claims can be re-processed with no issues.
• Using the PCP Selection Form, update Member’s PCP and demographics.
• Work PCP Error Report by correcting error in PCP Assignments (gaps in coverage, inappropriate assignments, etc.).
• Responsible for conducting all processes associated with enrolling newborns into the Plan, including Newborn Temporary Record Creation, Eligibility and Faxing).
• Research Casehead information from 834 data and MassHealth Virtual Gateway to update member’s casehead as appropriate.
• Performs other duties as assigned.

Qualifications:

Education:

• Associate degree or equivalent combination of education, training, and work experience is required.

Experience:

• 1 or more years experience in an administrative, clerical position within the insurance, financial or health care industry is required.
• Additional post-secondary education may be substituted for work experience.
• 1 year Operations experience in a managed care or healthcare environment is preferred.

Competencies, Skills, and Attributes:

• Excellent customer service skills are required.
• Detail oriented with a commitment to accuracy.
• A strong working knowledge of Microsoft Office products.
• Ability to work with a team as well as independently.

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Ability to work overtime in peak periods.

• Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

• All remote workers will be required to adhere to WellSense’s Remote Work Policy.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

• WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.