The Membership Administrator processes enrollment applications, maintains eligibility data, and reconciles individual and group billings. They also provide customer service to internal and external stakeholders while ensuring compliance with federal and state regulations.
The Care Management Nurse provides clinical care management, including assessment, planning, and coordination to meet member healthcare needs. They collaborate with internal and external stakeholders to ensure compliance with medical policies and promote quality, cost-effective outcomes.
Act as a guide and advocate for members and providers by answering inquiries regarding health insurance benefits, claims, and eligibility. Conduct research to resolve complex issues and provide accurate, compliant information to callers.
