Case Management, Assistant

Description:

Job Title
Senior Assistant, Case Management (HIPP / Premium Assistance) Alabama
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Organizational Context
Gainwell Technologies (through its HMS division) provides services to state Medicaid agencies, assisting with program integrity, eligibility, premium assistance, and health program operations. In Alabama, Gainwell / HMS supports the Alabama Medicaid HIPP (Health Insurance Premium Payment) / Premium Assistance program. Alabama Medicaid+1
The Senior Assistant will operate in compliance with federal and state Medicaid rules, HIPAA privacy/security requirements, and Alabama s specific program policies.
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Position Summary
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.
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Key Responsibilities & Duties
Core Case / Member Services
Provide enrollment assistance and guidance to Medicaid-eligible recipients and their families regarding the HIPP / Premium Assistance program via phone or correspondence. Gainwell Technologies Jobs
Verify, document, and investigate existing health coverage for Medicaid recipients and their dependents (employer plans, COBRA, etc.). Gainwell Technologies Jobs
Assist in identifying members who may qualify for HIPP / Premium Assistance. Gainwell Technologies Jobs
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.
Compliance & Policy
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.
Collaboration & Communication
Coordinate with state Medicaid agency staff, other Gainwell 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.
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Qualifications & Skills
Minimum / Required
At least 2 years of experience in health insurance, Medicaid, public health programs, or government-sponsored programs (or equivalent experience).
At least 2 years call center / phone-based experience (inbound and outbound) making inquiries, responding to recipients.
Strong customer service, written and verbal communication skills
Excellent organizational, detail orientation, and ability to work under deadlines
Ability to analyze data, apply logical reasoning, and make informed decisions
Proficiency in Microsoft Word, Excel, and familiarity navigating web-based systems or internal tools
Working knowledge of HIPAA privacy/security and handling of sensitive data
Ability to handle stress, prioritize competing tasks, and escalate appropriately
Professional demeanor, interpersonal skills, adaptability
Preferred / Desired
Experience specifically with HIPP, premium assistance, Medicaid or health insurance programs
Call center / high-volume case operations experience
Bilingual (especially in languages common in the region)
Familiarity with health care / insurance terminology
Previous experience with auditing, compliance, or fraud waste abuse program work
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Work Environment & Conditions
Location: Onsite in Montgomery, AL
Hours: Standard business hours, Monday Friday (with possible occasional overtime)
Travel: Minimal (in-state) as required for training, meetings, audits
Equipment: Standard office setup (PC, phone, secure access to case management systems)
Workload: High-volume case handling with performance metrics (turnaround times, accuracy, call volumes)

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