Customer Service Representative I – Medicaid Enrollment

. Resolve and reconcile enrollment reports and eligibility issues according to policy, procedure, and state coverage guidelines .

Posted 9/25/2026full-timeRemote • Pennsylvania • United StatesJuniorWebsite

Key responsibilities & impact

Resolve and reconcile enrollment reports and eligibility issues according to policy, procedure, and state coverage guidelines
Initiate communication and literature for newly enrolled health plan members, dependents, and employer groups
Interpret and apply rules and regulations in contractual agreements with employer groups and vendors
Perform membership data extraction reports for employer group audits and compliance with performance risk guarantee commitments
Update, approve, and interpret membership data and workflows in employer group online software modules
Determine member eligibility and process terminations and disenrollments
Prepare, generate, and distribute enrollment-related letters to subscribers and members
Determine whether services are covered benefits based on line of business and product design
Review suspended claims and resolve them using applicable policies, procedures, and product benefits
Provide team-building resources and direct peers to appropriate claims resolution policies and procedures
Provide daily support and advice to member and provider services staff regarding claims issues
Research claim issues from participating providers and identify criteria for payment reconsideration
Resolve customer concerns, provide education and instruction, and maintain customer satisfaction
Participate in cross-training and improve processes within the Customer Service team

What you’ll need

Comp & perks