Enrollment Specialist

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

📋 Description

• Support uninsured potential members in completing and submitting Medi-Cal applications via BenefitsCal or other relevant enrollment methods.

• Assist members with documentation, verification requirements, renewals, redeterminations, and subsequent steps.

• Track pending applications and eligibility status using BenefitsCal and approved systems.

• Follow up with members, counties, health plans, and other organizations to resolve any outstanding applications and eligibility concerns.

• Aid members in addressing denials, discontinuations, requests for information, reconsideration requests, and appeals.

• Assist members with options for Medi-Cal Managed Care Plans, including enrollment, assignment, and activation verification.

• Manage a pipeline of potential members through the stages of application, eligibility, MCP enrollment, authorization, and program readiness.

• Coordinate transitions with Member Engagement, Street Outreach, ECM, Community Supports, Lead Care Managers, and other departments.

• Maintain regular contact with members and clearly explain complex insurance and eligibility processes.

• Track important deadlines, notices, renewal dates, required actions, outreach attempts, and case statuses.

• Ensure accurate, complete, HIPAA-compliant, and audit-ready documentation is maintained.

• Report on pending cases, delays, denials, approvals, MCP assignments, and completed enrollments to leadership.

• Escalate urgent needs and complex eligibility issues in accordance with PHG protocols.

⛳️ Requirements

• High school diploma or equivalent.

• Experience in healthcare administration, insurance enrollment, eligibility, social services, patient navigation, member services, or a related field.

• Strong computer and data-entry skills.

• Excellent telephone communication and customer service abilities.

• High attention to detail and capability to manage multiple cases simultaneously.

• Ability to independently progress cases through various administrative steps until resolution.

• Capable of effective communication with individuals facing complex social and economic challenges.

• Ability to maintain confidentiality and adhere to HIPAA and organizational standards.

• Preferred: experience with Medi-Cal eligibility and enrollment.

• Preferred: familiarity with BenefitsCal.

• Preferred: understanding of California Medi-Cal Managed Care Plans.

• Preferred: experience assisting with Medi-Cal applications, renewals, appeals, or eligibility troubleshooting.

• Preferred: experience working with underserved, justice-involved, unhoused, or medically complex populations.

• Preferred: experience within CalAIM, Enhanced Care Management, Community Supports, managed care, or community health programs.

• Bilingual skills are strongly preferred.

• Must possess the ability to work independently in a remote setting.

• Ability to identify when an issue necessitates escalation.

• Comfort in communicating with counties, health plans, providers, and internal teams.

• Must maintain a private, HIPAA-compliant remote workspace.

• Requires extended periods of computer and telephone usage.

🏝️ Benefits

• 401(k) matching.

• Dental insurance.

• Health insurance.

• Life insurance.

• Paid time off.

• Vision insurance.

• Remote work arrangement.

• Occasional travel for training, meetings, or organizational needs.