What are the responsibilities and job description for the Discrepancy Resolution Specialist position at Labor First LLC?
LaborFirst is the leader in Care Navigation and advocacy, dedicated to improving outcomes and satisfaction for group plan sponsors and their members. Founded in 2005, we partner with all major national health carriers to serve 450 clients and over 375,000 Medical and Pharmacy lives across all 50 states. We deliver high-touch solutions that drive value while preserving benefits. RetireeFirst, a LaborFirst solution, provides end-to-end Retiree Benefits Management. In partnership with plan sponsors, brokers, and consultants, we design, implement, manage, and administer Medicare benefits, ensuring a seamless transition and continued support. HealthActive, our solution for self-insured health plans with actives and early retirees, combines one-on-one health advocacy with technology-driven insights to help members successfully navigate their healthcare journey.
Responsible for activities related to insured member eligibility, enrollment, and member onboard communication, which includes eligibility data file and case management to ensure processed updates are accurate and compliant with Centers for Medicare and Medicaid (CMS) with standardized internal/external required formats.
Role Responsibilities:
- Processes initial eligibility and updates according to client and/or carrier specifics
- Handles and manipulates data files in excel, txt, and other formats with adherence to information security and best practice processes for data file loading integrity
- Quality checks eligibility and enrollment updates and member communications to ensure seamless onboarding experience and CMS compliance
- Communicate clearly through multi-channels on actions taken, next actions and status to support transparent understanding of eligibility and enrollment progress
- Develops, evaluates and modifies processes and best practice methodologies at client and carrier levels to support continuous improvement
- Responsible for data integrity in all manners of eligibility and enrollment processing
- Adheres to strict policies and procedures, as our processes require CMS and carrier compliance
- Interacts with members when needed to support enrollment or disenrollment processing