Senior Enrollment Specialist

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.

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 the trainings scheduled by the client and employer
• Mentor junior members of the team
• Collaborate with other team members on special projects, including process documentation development, training, quality reviews for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality
• Participate in projects as assigned by management
• Perform other duties as assigned

Requirements

• 5+ years of professional experience in processing Medicare enrollment transactions
• 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; Medicaid knowledge is a plus
• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
• High school degree required
• Willingness to learn
• Strong work ethic

Skills

• Ability to adapt quickly to a challenging environment
• Self-starter and quick learner
• Team collaborator
• Ability to collaborate across multiple time zones in a hybrid or remote work environment

Pay

The annual US base salary range for this position is $50,000 to $56,000.

Schedule

• Full-time, permanent
• Remote, US

Work Environment

• 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
• Long periods of time sitting and/or standing in front of a computer using video technology
• May require travel dependent on company needs