Commercial Enrollment Specialist II

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

📋 Description

• Prepare, process, and manage enrollment and disenrollment requests.

• Verify and uphold all relevant eligibility criteria.

• Review and handle CMS transactions.

• Assess Medicaid eligibility and complete verification procedures.

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

• Reconcile membership reports as mandated by CMS.

• Guide junior team members.

• Collaborate on special initiatives, including process documentation, training, and quality assessments.

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

• Engage in projects assigned by management.

• Perform additional duties as necessary.

• Report directly to the Enrollment Manager.

⛳️ Requirements

• A 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 relevant enrollment-related guidelines.

• Experience in Medicaid enrollment is advantageous.

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

• Capability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operational reports, presenting findings in a structured manner.

• Eagerness to learn.

• Ability to work collaboratively within a team.

• Strong work ethic.

• Capacity to quickly adapt to a demanding environment.

• Self-motivated and quick to learn.

• Must successfully complete training scheduled by clients and employers.

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

🏝️ Benefits

• Remote work environment.

• Hybrid or remote work options.

• Travel may be required based on company needs.

• Reasonable accommodations provided for individuals with disabilities.

• Equal opportunity employer dedicated to workforce diversity.