Senior Enrollment Specialist

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

📋 Description

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

• Verify and uphold relevant eligibility criteria.

• Review and handle CMS transactions.

• Assess Medicaid eligibility and carry out verification procedures.

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

• Reconcile membership reports as mandated by CMS.

• Create case files for enrollment and billing discrepancies for CMS Contractor approval and resolution.

• Participate in and successfully complete client and employer training sessions.

• Mentor junior team members.

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

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

• Engage in projects assigned by management.

• Carry out other assigned responsibilities.

⛳️ Requirements

• A minimum of 5 years of professional experience processing Medicare enrollment transactions.

• Comprehensive understanding of Medicare Advantage products.

• Familiarity with CMS transaction files and enrollment-related regulations.

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

• Knowledge of Medicaid is advantageous.

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

• Ability to present findings in a well-structured format.

• High school diploma required.

• Openness to learning new skills.

• Capacity to work collaboratively as part of a team.

• Strong work ethic.

• Ability to quickly adapt to a fast-paced environment.

• Self-motivated and quick to learn.

• Ability to work across multiple time zones.

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

🏝️ Benefits

• Full-time, permanent employment.

• Training organized by the client and employer.

• Opportunity to mentor junior team members.

• Remote work setting.

• Reasonable accommodations for individuals with disabilities.

• Commitment to equal opportunity and workforce diversity.