Enrollment Team Lead

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology.

At UST HealthProof, you will join a fast-paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plan customers and their members. By creating a modern, cloud-based, best-in-class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured.

About the role

UST HealthProof is seeking an Enrollment Team Lead to report to the Enrollment Manager. The Enrollment Team Lead is responsible for supporting key processes to ensure the smooth operation of the Enrollment Operations Business Unit. This position plays a critical role in supporting client value delivery within the Business Unit.

Responsibilities

• Navigate and effectively interpret regulations and guidance in accordance with the CMS Manual System and other regulatory agencies guidelines
• Assist with the development and/or review of policies and procedures to ensure compliance with CMS regulations
• Assist in researching, analyzing, and disseminating new and existing CMS guidance and communications to cross-functional business units and internal/external stakeholders
• Assist and partner with business units with the development and/or improvement of workflows and business processes to improve controls and overall quality
• Assist with the development and recommendations for ongoing improvement of core processes
• Assist onshore and offshore personnel by answering questions, supplying information, and providing coaching/training as appropriate
• Recommend process improvements in support of positive SLA results
• Write and maintain documents related to Enrollment’s internal functions
• Serve as a Lead Enrollment SME
• Manage and process discrepancy queues, RPC, LEP, briefcases, and JIRA tickets
• Assist with audits, oversee correspondence submissions, generate client reports, maintain inboxes, and delegate tasks

Requirements

• 7+ years’ experience in a related field, typically in two subject areas (e.g., process improvement, project planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management)
• Thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines
• Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions
• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports, presenting findings in a structured way
• Bachelor’s degree in a related field; relevant combination of education and experience may be considered in lieu of a degree
• Proficient in current industry-standard PC applications and systems (e.g., Access, Excel, Word, and PowerPoint)
• Willingness to learn and collaborate as part of a team
• Significant creativity and flexibility
• Strong work ethic

Work Environment

• Remote, US-based role
• Full-time, permanent position
• The employee is occasionally required to move around the office
• Specific vision abilities required include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus
• Work across multiple time zones in a hybrid or remote work environment
• Long periods of sitting and/or standing in front of a computer using video technology
• May require travel dependent on company needs

Pay

The annual US base salary range for this position is $95,000 to $103,000. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, skills, experience, qualifications, and education.