Enrollment specialist vs benefits representative

Differences between enrollment specialist and benefits representative duties and responsibilities

Enrollment specialist example responsibilities.

• Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
• Manage customer relations with internal personnel, group administrators, brokers and members as related to HMO commercial insurance.
• Maintain records pertaining to eligibility and enrollment by managing CMS reports.
• Provide enrollment counseling to eligible recipients about Medicaid manage care and promote their voluntary enrollment into an HMO.
• Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
• Assist medical assistance consumers with choosing HMO's and PCP as well as with HMO and PCP transfers.
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Benefits representative example responsibilities.

• Determine eligibility and process FMLA initial notification letters for employees which lead to immediate use of benefits.
• Service consumers inbound inquires via phone and live chat regarding HRA, FSA and HSA accounts.
• Work with clients to ensure ACA compliance.
• Train in and apply HIPAA privacy and security regulations and maintain strict confidentiality of claims.
• Contact any FSA or HRA groups concerning any outstanding payments for claims and/or admin fee invoices.
• Produce benefit-related reports from HRIS.
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