Fallon Health · 17 hours ago
Senior Care Enrollee Services Representative
Worcester, MA, US
Full-time
Onsite
Mid, Senior Level
1+ years expFallon Health is a company dedicated to providing high-quality coordinated care. The Senior Care Enrollee Services Representative is responsible for processing enrollment applications and addressing enrollee inquiries related to Medicare and Medicaid benefits, serving as a liaison between enrollees and the organization.
FitnessHealth CareMedical
Responsibilities
Provides coverage for the NaviCare enrollment ACD line and handles Enrollees inquiries in a timely manner
Serves as a subject matter expert in the NaviCare product and benefits
Processes enrollment applications in accordance with regulatory requirements and departmental policies. Strict adherence to department turn-around time standards. Ensures the enrollment database is maintained on a daily basis
Validates enrollment with the confirmation of receipt of the enrollment (834) transaction
Handles enrollees’ inquires in a timely manner and Utilizes CMS approved scripts as appropriate
Assists enrollees with their inquires related to Medicare and Medicaid benefits
Supports the outreach and enrollment teams as a resource
Handles enrollee’s billing issues and presents them to NaviCare Clinical Directors or other internal and external physician reviewers as appropriate
Assist contracted providers with pending claims issues
Ability to protect high degree of confidential/privileged patient and proprietary business information
Ability to function effectively in a fast-paced environment and effectively deal with competing priorities
Ability to synthesize all applicable regulatory requirements for NCQA, CMS and SCO contract
Qualification
Required
Bachelor's degree or equivalent combination of education and experience
Annually, required to pass a product certification exam
Annually, required to take the AHIP certification
1 – 3 years of previous professional experience in a related position, preferable healthcare
Ability to communicate and present information to various levels of personnel
Working knowledge of computer programs and software
Excellent interpersonal skills, ability to negotiate with customers and remain diplomatic
Ability to protect high degree of confidential/privileged patient and proprietary business information
Ability to function effectively in a fast-paced environment and effectively deal with competing priorities
Ability to synthesize all applicable regulatory requirements for NCQA, CMS and SCO contract
Company
Fallon Health
Founded in 1977, Fallon Health is a community-focused not-for-profit health care services organization based in Worcester, Massachusetts.
1001-5000 employees
H1B Sponsorship
Fallon Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (8)
2024 (8)
2023 (5)
2022 (9)
2021 (7)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Dorothy Vandette
Manager, CEO Office
Todd Bailey
Senior Vice President, Chief Financial Officer
Recent News
2026-01-09
2025-08-07
2025-06-07
Company data provided by crunchbase