Enrollment and Eligibility Specialist

Job Summary

To support the Enrollment and Eligibility/Employer Services Department, the full-time remote Enrollment and Eligibility Specialist will manage the enrollment and eligibility processing, ensuring accurate participant enrollment in health plans while providing support to clients and members through effective communication.

Key responsibilities

• Create, audit, process, and update member and eligible dependents' profiles in the enrollment database
• Reconcile eligibility discrepancies and analyze transactional data for retroactive eligibility changes
• Address Enrollment and Eligibility inquiries from clients, employer partners, and call center representatives

Required qualifications

• Bachelor's Degree preferred or High School diploma/GED with 5-7 years of equivalent experience
• 2+ years of experience in an office environment using telephone and computer for job duties
• Knowledge of managed care and commercial carrier enrollment and eligibility procedures
• Proficiency in HIPAA, COBRA, and other eligibility-related regulations preferred
• Moderate proficiency with Windows 365 applications and ability to learn complex computer systems