Medicare Enrollment Specialist II

About the role

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. As part of HealthProof, you will join a fast-paced, growing company reshaping the future of health insurance by reducing administrative costs and building better healthcare experiences for health plans and their members. You will support proven core administration solutions and business process-as-a-service (BPaaS) operations to improve transparency, operational efficiency, and strategic growth.

Responsibilities

• Prepare, process, and maintain enrollment and disenrollment requests.
• Verify and maintain all applicable eligibility requirements.
• Review and process CMS transactions.
• Review Medicaid eligibility and complete verification processes.
• Resolve enrollment system rejections based on regulatory and client-specified guidelines.
• Reconcile membership reports as required by CMS.
• Attend and successfully complete trainings scheduled by the client and employer.
• Mentor junior members of the team.
• Collaborate with other team members on special projects, including process documentation, training, and quality reviews.
• Establish and maintain communication with management to address issues, concerns, and preventive measures for case accuracy and quality.
• Participate in projects as assigned by management.
• Perform other duties as assigned.

Requirements

• High school diploma or GED required.
• 2 years of professional experience in processing Medicare enrollment transactions.
• Thorough understanding of Medicare Advantage products, CMS transaction files, and enrollment-related guidelines; Medicaid enrollment experience a plus.
• Experience with CMS interfaces and systems for managing Medicare Advantage enrollment and billing functions.
• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operational reports.
• Willingness to learn and collaborate as part of a team.
• Strong work ethic.

Skills

• Ability to adapt quickly to a challenging environment.
• Self-starter and quick learner.
• Strong collaboration skills.

Work Environment

The role is remote within the US and involves:

• Occasional movement around the office (if applicable).
• Long periods of sitting and/or standing in front of a computer using video technology.
• Work across multiple time zones in a hybrid or remote environment.
• Specific vision abilities required, including close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Potential travel dependent on company needs.

Pay

The annual US base salary range for this position is $40,000 to $44,000. Final compensation will be determined during the interview process based on skills, experience, qualifications, and education.