Enrollment Specialist

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

📋 Description

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

• Confirm and uphold all relevant eligibility criteria.

• Review and manage CMS transactions.

• Assess Medicaid eligibility and carry out verification procedures.

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

• Reconcile membership reports as mandated by CMS.

• Attend and successfully complete training sessions provided by clients and employers.

• Provide guidance to 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.

• Carry out other duties as required.

⛳️ Requirements

• High school diploma is mandatory.

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

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

• Experience in Medicaid enrollment is advantageous.

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

• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operational metrics, presenting findings in an organized manner.

• Willingness to learn and grow.

• Collaborative team player.

• Strong work ethic.

• Capacity to quickly adapt to a dynamic environment.

• Self-motivated and quick learner.

• Ability to work collaboratively.

• Capability to work across various time zones.

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

🏝️ Benefits

• Remote work environment.

• Hybrid or remote work options available.

• Training organized by the client and employer.

• Opportunities for mentoring.

• Travel may be required based on company needs.

• Reasonable accommodations for individuals with disabilities.

• Commitment to equal opportunity and workforce diversity.