Eligibility/Premium Assistance Insurance Representative - HIPCA/MIDAP

MPHI is a Michigan-based and nationally engaged, non-profit public health institute. We are a team of teams, process and content experts, dedicated to building A world where tomorrow is healthier than today!

Title: Eligibility/Premium Assistance Insurance Representative - HIPCA/MIDAP

$24.48 - $31.91 / Posted Thru: 3-30-2026

Location: Remote/Virtual - Must work and live in the state of MI

Purpose: The MichiganDrug AssistanceProgram (MIDAP)is responsible for ensuring that eligible people living with HIV/AIDS (PLWHA) have access to prescription medications. This position will be responsible for assisting clients with enrolling in the MIDAP Program as well as accessing client information for health insurance premium assistance. MIDAP plays a key role in balancing the federal requirements of cost containment and cost avoidance while ensuring that Michigan's clients receive quality services.

Duties and Responsibilities:

• Check the secured fax for HIPCA claims daily.
• Retrieve any HIPCA claims for processing.
• Analyze eligibility on all HIPCA claims.
• Complete the MIDAP HIPCA Claim form.
• Analyze individual Insurance/Billing statements for each HIPCA claim.
• Analyze all Insurance/Billing statement Claims with HIPCA Committee once a week for final approval/denial/incomplete.
• Document all HIPCA claims (Approvals/Denials/Incompletes) in Excel spreadsheet.
• Document all HIPCA claims (Approvals/Denials/Incompletes) in CAREWare.
• Document all DMR claims (Approvals/Denials/Incompletes) in Excel spreadsheet.
• Call Case Managers/Agencies back for all incomplete and denied HIPCA/DMR claim.
• Send Approved Claims to SGRX via fax, with follow-up email to make sure they got it.
• Send follow-up email to SGRX, to retrieve payment information on individual claims paid as well as to get individual check numbers to be entered into CAREWare.
• Compare SGRX payments to internal spreadsheets and contact SGRX with discrepancies and notify MDHHS operations.
• Send SGRX payment information to MDHHS for reconciliation.
• Answer incoming calls, provide direct support, and respond to complex questions pertaining to coverage, program eligibility, program policies, procedures, and billing issues.
• Coordinate client contact and follow up with insurance companies to resolve issues, such as, non-payment of client portion, termination of insurance policies, renewal concerns.
• Determine eligibility for premium assistance for Medicare Part D, Qualified Health Plans, COBRA, and private policies.
• Coordinate with SGRX to process premium assistance payments and adjustments and maintain a detailed tracking and reporting system.
• Enter required data into CAREWare and ScriptGuideRx to meet program requirements.
• Assist in the development, coordination and presentation of premium assistance and open enrollment trainings, webinars and updates to case management agencies, planning groups, collaborative meetings, as well as other internal unit, section, and division staff.
• Participate in all required trainings, including confidentiality and security trainings and sign oath of confidentiality.
• Process Adjustments and Closures for MIDAP Premium Assistance Clients.
• Log and distribute refund checks to the proper channels for completion.
• Create and distribute Premium Assistance letters and forms during Open Enrollment.
• Deliver professional, courteous, and timely services to clients/customers.
• Monitor eligibility enrollment of Premium Assistance clients.
• Utilize software applications - CAREWare, ScriptGuideRx, Bridges and CHAMPS - to review and/or record data, document inquiries, non-compliant issues, etc. and ensure MIDAP is the payer of last resort for eligible clients.
• Remain updated on HIV/AIDS knowledge and requirements (state and federal) by reviewing memos, bulletins, letters, email messages, policy changes, etc. This new information must be incorporated into his/her daily use by understanding how it impacts the clients.
• Conduct MIDAP online testing.
• Provide program support, including clerical, preparing, and reviewing mailings to clients, case managers, pharmacies, and benefit managers, and preparing presentations.
• Always represent the best interests of MDHHS and MPHI.
• All other duties as assigned by the MIDAP Coordinator, MIDAP Manager, Continuum of Care Unit Manager or Section Manager.

Qualifications/Requirements:

Education: Bachelor's degree.

Experience: One year of experience working with health care programs, Medicaid, State Assistance, or other insurance providers. Experience in billing and/or processing claims is preferred. Proficiency in Microsoft Office applications. Experience in health care or public health field.

Important Skills and Characteristics:

• High level of initiative and accountability.
• Ability to effectively communicate with diplomacy under challenging circumstances.
• Able to work well in teams.
• Self-motivated, able to complete work in timely manner, and handle multiple tasks at one time with minimal supervision.

Work Environment and Physical Requirements: Job may require moderate physical effort including lifting materials and equipment of <25# and involves viewing a CRT or VDT screen 50% to 75% of the time and handling phone inquiries 90% of the time. Standard office environment. Requires valid vehicle operator's license where needed to perform duties of the position. Frequent deadlines. May require in-state and out-of-state travel for related meetings.

RESPONSIBILITY FOR THE WORK OF OTHERS: No assigned responsibility.

IMPACT ON PROJECTS, SERVICES AND OPERATIONS: This position has a direct impact on the quality of services provided by MPHI to MDHHS. Perform as a critical member of a team of professionals working to reduce transmission of HIV and to ensure access to and retention in care for persons in Michigan infected with HIV.

REQUIRED COMMUNICATION

Contact Person/Group	Frequency	Purpose
Unit Manager	Daily/Weekly	Supervision/Task Overview
Section Manager	Daily/Weekly	Supervision/Task Overview
MIDAP Team	Daily	Collaboration

For purposes of employment standards, this classification is "Non-Exempt" from overtime provisions of the fair Labor Standards Act.

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MPHI is an EEO employer that participates with e-verify.