Heathcare Enrollment Specialist

Healthcare Enrollment Specialist

LONG TERM CONTRACT

FULLY REMOTE

STARTS ASAP

Job Title: Healthcare Enrollment Specialist

Location: Remote

Job Summary

We are seeking a detail-oriented and dependable Enrollment Specialist to join our team. You will be responsible for accurately processing health plan enrollment, changes, and terminations for our members. You will work within our healthcare administration software, ensure compliance with regulatory standards (CMS, ACA, state guidelines), and support smooth operations for our health plan members.

Key Responsibilities

• Application Processing: Review, verify, and process incoming health plan enrollment applications, demographic updates, plan changes, and coverage terminations.
• Data Verification: Verify member eligibility, dependent information, supporting documentation, and qualifying life events (QLEs) to ensure data accuracy.
• System Entry: Accurately enter and maintain member data across internal enrollment platforms, electronic data interchange (EDI) error queues, and database systems.
• Issue Resolution: Identify and resolve routine enrollment discrepancies, missing information, or processing errors in a timely manner.
• Interdepartmental Collaboration: Partner with Member Services, Billing, and Claims teams to address member inquiries regarding eligibility status and coverage start dates.
• Compliance & Standards: Adhere strictly to HIPAA guidelines, health plan compliance standards, and internal turnaround time (TAT) metrics.

Required Qualifications

• Experience: 2+ years experience in healthplan enrollment
• Technical Skills: Basic proficiency with Microsoft Office (Excel, Word, Outlook) and comfortable learning new database software quickly.
• Attention to Detail: Excellent data entry speed and precision with low error rates.
• Communication: Clear written and verbal communication skills for cross-departmental coordination.
• Problem-Solving: Strong organizational skills with the ability to manage repetitive tasks efficiently and follow standard operating procedures (SOPs).

Additional Qualifications

• Basic understanding of health insurance concepts (e.g., ACA, Medicare, Medicaid, premiums, eligibility periods).
• Familiarity with 834 EDI transactions or healthcare administration platforms (e.g., Facets, QNXT, Salesforce).

Key Competencies & Traits

• Adaptable: Quick to pick up system updates and process changes in a fast-paced environment.
• Quality-Driven: Takes pride in accuracy and ensuring member records are correct from day one.
• Reliable: Meets regular attendance and performance benchmarks for queue processing.