Human Resources/Enrollment Specialist

Requirements

• HS diploma or equivalent education/experience
• 1 year recent relevant experience in health plan enrollment, eligibility, insurance, or healthcare operations
• Experience with member/group enrollment, terminations, demographic updates, PCP changes, and eligibility verification
• Reconciliation of eligibility discrepancies, review of pending enrollment data, and processing of retroactive eligibility changes
• Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint
• Experience with database management, data validation, enrollment system uploads, and file layouts
• Maintenance of PHI confidentiality and adherence to audit controls, production standards, and regulatory requirements
• Communication with brokers, customers, vendors, internal teams, and Member Services to resolve enrollment issues

Preferred Requirements

• Working knowledge of health insurance enrollment and eligibility practices
• Familiarity with DMHC regulations, managed care, reimbursement models, payer relationships, and pricing mechanisms
• Experience with Microsoft Access, SQL Server, spreadsheet solutions, or FSA file layouts
• Strong attention to detail, organization, time management, and ability to manage multiple priorities
• Analytical, negotiation, and project coordination skills
• Support of open enrollment and annual enrollment readiness with cross-functional teams

Summary / Duties

Support plan enrollment operations by preparing, processing, uploading, and maintaining member and group registration information in enrollment databases. Responsibilities include:

• Entering new enrollments and terminations, updating demographic and PCP information, verifying eligibility status, resolving discrepancies, analyzing transactional data, and submitting retroactive eligibility changes when needed.
• Responding to eligibility inquiries, generating member correspondence, processing duplicate ID card requests, reviewing enrollment submissions for accuracy, and communicating with brokers, customers, vendors, Member Services, and internal teams to obtain missing information or resolve file issues.
• Supporting data audits, inventory control, regulatory compliance, PHI protection, and open or annual enrollment readiness.