Customer Service Representative I - Medicaid Enrollment, Geisinger Health Plan (Pennsylvania resident)

Role overview

Help health plan members and employer groups resolve enrollment and coverage questions. This customer service role combines eligibility administration, written member communications, and research into claims and benefits issues, while supporting colleagues with policy and process guidance.

Responsibilities - Investigate enrollment reports and eligibility discrepancies, applying relevant plan rules and state requirements. - Process member eligibility decisions, terminations, and disenrollments, and send clear notices about enrollment activity. - Communicate with newly enrolled members, dependents, and employer groups, and prepare membership data extracts for review and compliance checks. - Review claims questions and suspended claims against the applicable product benefits and procedures; identify issues that may warrant payment reconsideration. - Advise member and provider service colleagues on claim resolution procedures and help improve team workflows through cross-training.

Requirements - High school diploma or equivalent. - At least one year of customer service experience. - Clear communication and a customer-focused approach, including the ability to support customer retention. - Ability to interpret plan rules and follow established procedures when resolving eligibility and claims issues.

Benefits and work setup - Remote work for residents of Pennsylvania; full-time schedule of 40 hours per week on day shifts. - Medical, dental, and vision coverage is available from the first day for eligible full-time and part-time employees.