Health Admin Associate (Medical Back Office Case Worker)

Health Admin Associate (Medical Back Office Case Worker)

Job Description

Job Title: Health Admin associates

Location

Work From Office (Onsite)

Job Summary
We are seeking a detail-oriented and highly organized Medical Back Office Case Worker to support healthcare administration and member services operations. The ideal candidate will have a foundational understanding of the healthcare and health insurance industry, experience handling member records and enrollment activities, and the ability to process high volumes of work accurately in a fast-paced environment. This role requires strong analytical skills, attention to detail, and proficiency in Microsoft Office applications.

Key Responsibilities

Member and Case Processing

• Review, update, and maintain member records accurately and efficiently.
• Process healthcare enrollment, eligibility, and member maintenance requests.
• Validate member information and ensure data integrity across systems.
• Research and resolve discrepancies related to member accounts and enrollment records.
• Track and manage cases through completion while adhering to established turnaround times.

Data Management

• Perform high-volume data entry with a strong focus on accuracy and quality.
• Update databases and internal systems with member and case information.
• Generate reports and provide regular status updates to leadership.
• Maintain confidentiality of sensitive healthcare and member information.

Healthcare Administration

• Support processes related to Medicare, Medicaid, Medicare Advantage (MA), Dual Special Needs Plans (D-SNP), and Managed Care programs.
• Review documentation for completeness and compliance with program requirements.
• Assist with eligibility verification and member record maintenance activities.
• Collaborate with internal departments to resolve healthcare-related inquiries.

Quality and Compliance

• Ensure compliance with company policies, HIPAA guidelines, and healthcare regulations.
• Meet established productivity, quality, and service-level expectations.
• Participate in quality audits and process improvement initiatives.
• Maintain accurate documentation and case notes.

Required Qualifications

• High School Diploma or GED required; Associate's degree preferred.
• Basic knowledge of the healthcare and health insurance industry.
• Understanding of healthcare terminology and member administration processes.
• Knowledge of enrollment, eligibility, and member maintenance activities.
• Strong data entry and typing skills with a high level of accuracy.
• Proficiency in Microsoft O