Enrollment Specialist I - Hybrid

This is a full-time hybrid position based in the Pittsburgh/Erie area. While you'll primarily work remotely, you'll come into the office occasionally depending on departmental needs. The pay rate is $20.70 per hour.

About the role

As an Enrollment Specialist, you will be responsible for the creation and maintenance of eligibility in the transactional system, responding to both internal and external customer inquiries, and resolving issues to meet or exceed service requirements. You must have a comprehensive understanding of enrollment regulations and complete all duties with strict regard to policies and procedures set by the Enrollment Services Manager, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID).

Responsibilities

• Understand varied and detailed enrollment and disenrollment requirements and processing rules based on the product (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group, including the application of service areas by product.
• Maintain employee/insured confidentiality.
• Analyze information to make appropriate decisions regarding enrollment/disenrollment, complying with applicable regulations and governance.
• Interact with Sales staff to ensure all required data elements for completed applications are received and any issues are addressed timely, in accordance with compliance requirements.
• Make eligibility determinations based on CMS (Part A/Part B Eligibility), DPW (Medical Assistance Eligibility), and/or PID requirements, in accordance with the application election period guidelines.
• Accurately identify appropriate election periods based on analysis of beneficiary/member history and regulatory guidance.
• Apply eligibility regulations to process enrollment transactions and generate corresponding letters to members; keep up to date with new regulations and guidance.
• Process all types of enrollment and disenrollment transactions in accordance with company policies and procedures in a timely manner while meeting production and quality goals.
• Initiate and generate appropriate correspondence based on the type of transaction processed, including outreach requests and written correspondence (letters), as necessary.
• Handle daily clerical responsibilities related to processing and electronic storage of member correspondence.
• Identify areas of concern or trends that may compromise client satisfaction or compliance with government regulations.
• Support team projects within Enrollment Services; other projects as assigned.

Requirements

• High school graduate or equivalent required; college degree preferred.
• Minimum of six months of customer service and/or call center experience.
• Ability to interpret and apply complex eligibility regulations as mandated by CMS, DPW, and PID.
• Strong organizational, interpersonal, leadership, and communication skills.
• Attention to detail is critical, with skills in customer orientation.
• Ability to manage multiple tasks and projects.
• Proficiency in MS Office/PC skills.