Commercial Enrollment Specialist II

This is a fully remote position, open to applicants in United States.

📋 Description

• Prepare, manage, and keep track of enrollment and disenrollment requests.

• Verify and uphold relevant eligibility criteria.

• Review and process transactions related to CMS.

• Assess Medicaid eligibility and carry out verification procedures.

• Address enrollment system rejections in accordance with regulatory and client-specific standards.

• Reconcile membership reports as mandated by CMS.

• Attend and successfully complete training sessions for clients and employers.

• Provide mentorship to junior team members.

• Collaborate on special projects, including the documentation of processes, training initiatives, and quality assessments.

• Communicate with management regarding issues and concerns, taking preventive measures to ensure accuracy and quality in cases.

• Engage in projects assigned by management.

• Execute other assigned responsibilities.

⛳️ Requirements

• High school diploma is required.

• 3–5 years of professional experience in processing Medicare enrollment transactions.

• Comprehensive understanding of Medicare Advantage products, CMS transaction files, and enrollment-related guidelines.

• Experience with Medicaid enrollment is a plus.

• Familiarity with CMS interfaces and systems for Medicare Advantage enrollment and billing operations.

• Ability to analyze enrollment reconciliation data and report on SLAs, KPIs, and other operational metrics.

• Capability to present findings in an organized manner.

• Willingness to learn and expand skill sets.

• Ability to work collaboratively as part of a team.

• Strong work ethic.

• Adaptability to rapidly changing environments.

• Self-motivated and quick to learn.

• Capacity to work across multiple time zones.

• Candidates may need to undergo a pre-employment criminal background check.

🏝️ Benefits

• Training organized by the client and employer.

• Opportunities for mentorship.

• Hybrid or remote work options available.

• Possible travel based on company requirements.

• Reasonable accommodations for individuals with disabilities.

• Commitment to equal opportunity employment.

• Permanent employment position.