When clients transition into a new Group Medicare plan, one of the most critical elements is ensuring that eligibility, enrollment, and member data flows smoothly, both at go-live and on an ongoing basis. With RetireeFirst, a LaborFirst solution, we’ve built an entire process around making this transition as seamless as possible by working directly with both our client and carrier partners every step of the way.
Flexible Data Intake, No File Conversions Required
We know that every client has their own systems, processes, and file formats. That’s why we accept eligibility data in any standard format, whether it’s Excel, CSV, or a flat file, eliminating the need for time-consuming file conversions. There’s no rigid template or technical barrier. We adapt to each client’s preferred file structure, streamlining implementation and minimizing disruption. Eligibility files are reviewed using built-in validation rules to catch any issues prior to a secure FTP upload to the carrier.
Proactive Issue Resolution with Direct Member Support
When a carrier identifies any discrepancies in enrollment files, we don’t wait for issues to escalate. Our Advocate team proactively reaches out to members directly, by phone, email, or mailed correspondence, to gather or confirm missing information. Our internal systems also cross-check addresses against USPS and CMS databases.
After we correct the records, we re-upload to the carrier, reducing delays and keeping member enrollment on track. By fixing discrepancies quickly, we reduce administrative headaches for both the client and carrier, and—most importantly—prevent coverage interruptions for members.
High-Touch, Age-In Support
Aging into Medicare can be confusing, but we help simplify the experience for both plan sponsors and their members. With carrier integrations already in place, we proactively monitor client-provided age-in lists up to a year in advance. Our team initiates personalized outreach, including welcome kits, calls, and postcard reminders, to ensure members receive timely enrollment guidance and complete necessary forms. We manage this entire process in coordination with the carrier, ensuring every age-in is enrolled accurately and on time, while minimizing client involvement.
Ongoing Eligibility Management
Our work doesn’t stop after implementation. We continue managing eligibility updates throughout the life of the plan, including new enrollments, disenrollments, and any changes in status. In coordination with our carrier partner, member records are regularly reconciled with CMS data to ensure alignment across all systems. We also support Medicare enrollment for retirees residing abroad, members aging into Medicare due to disability, and other unique scenarios.
Carrier Collaboration Built on Experience
Because we can work with all major national and regional carriers, we understand the nuances of each carrier’s processes and technical requirements. Our carrier partnerships allow us to navigate complex data exchanges, file testing, and reporting with efficiency—reducing stress for our clients and creating a true partnership approach.
Our Shared Goal: A Seamless Member Experience
By managing the technical details, coordinating directly with our carrier partners, and proactively resolving issues, we help ensure that clients and retirees have a consistent, positive experience with uninterrupted coverage and personalized support from their dedicated team.
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