Senior Assistant, Case Management (HIPP / Premium Assistance)

Description :

The Senior Assistant (Case Management) will support the HIPP / Premium Assistance program by handling case-level operations : verifying insurance coverage, maintaining case files, processing premiums and payments, interacting with recipients and employers, and ensuring program compliance. This role helps ensure that Medicaid pays premiums only when cost-effective and that eligible recipients benefit appropriately.

What You Will Do :

• Provide enrollment assistance and guidance to Medicaid-eligible recipients and their families regarding the HIPP / Premium Assistance program via phone or correspondence.
• Verify, document, and investigate existing health coverage for Medicaid recipients and their dependents (employer plans, COBRA, etc.).
• Assist in identifying members who may qualify for HIPP / Premium Assistance.
• Obtain and verify documents required for eligibility : insurance policies, employment verification, premium invoices, etc.
• Maintain active case files during open enrollment cycles, premium review, and payment processing.
• Process, review, and follow up on premium payments / reimbursements, ensuring timely and accurate payments, and tracking any discrepancies.
• Perform ongoing case maintenance and audits, updating records for status changes, renewals, terminations, or escalations.
• Complete periodic reporting (e.g. case metrics, enrollment trends, audit reports) as required by state or internal stakeholders.
• Respond to high volumes of inbound and outbound calls and inquiries about eligibility, coverage, program rules, and status.
• Conduct advanced document review, legal research or case escalation as needed, particularly on more complex cases.
• Prioritize case events, manage deadlines, escalate issues to supervisors or subject matter experts when appropriate.
• Ensure strict adherence to HIPAA privacy and security standards when handling protected health information (PHI).
• Follow Medicaid, federal, and Alabama-specific HIPP / premium assistance rules, policies, and procedures.
• Support internal or external audits, submitting documentation and explanations for case decisions.
• Participate in training, quality assurance, and performance improvement programs related to case management operations.
• Coordinate with state Medicaid agency staff, other internal teams, employers, insurers, and service providers as needed.
• Liaise with internal audit, legal, compliance, and escalation teams to resolve disputes or complicated cases.
• Provide feedback or suggestions to improve processes, workflows, policies, or system tools.

What You Will Bring :

About Impresiv Health :

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!