Medicare Enrollment Specialist

Accountabilities:

Review and process Medicare enrollment applications, verifying the accuracy, completeness, and validity of submitted member information.
Determine whether applications should be approved for enrollment, referred for additional outreach, or rejected based on eligibility criteria, established policies, and applicable procedures.
Enter and verify enrollment information in relevant systems, ensuring data accuracy and maintaining reliable member records.
Investigate and resolve enrollment discrepancies and administrative issues to provide members with an efficient and seamless enrollment experience.
Maintain and update Medicare member enrollment records annually, documenting changes, processing updates, and conducting outreach when required.
Manage departmental work queues and meet established productivity, accuracy, and quality standards.
Coordinate and maintain Coordination of Benefits (COB) information within member records.
Process Special Needs Plan (SNP) applications by verifying eligibility requirements, including dual-eligibility status and residency within the applicable service area.
Support Medicare enrollment operations by reviewing elections, transaction codes, reconciliation activities, and other relevant enrollment processes.
Manage Late Enrollment Penalty (LEP) information for Medicare Advantage Prescription Drug (MAPD) members, where applicable.
Communicate effectively with internal departments, external partners, and other stakeholders to address enrollment-related questions and resolve issues.
Escalate complex cases and operational concerns to the appropriate level of supervision when necessary.
Participate in department training programs and develop and deliver training sessions to support the onboarding and development of new employees.
Contribute to system and user acceptance testing activities related to new developments, system enhancements, and operational rollouts.
Support departmental planning and preparation for successful annual Open Enrollment periods.
Perform additional responsibilities and special assignments as directed by management.
Requirements:
High school diploma or equivalent, with at least one of the following qualifications:
Two years of experience working with medical or institutional data entry and two years of customer service experience.
One year of experience in Medicare eligibility and Medicare enrollment processing.
A bachelor's degree.
An associate degree or higher in a healthcare-related field is preferred.
Three to five years of experience in Medicare enrollment processing and customer service is preferred.
At least two years of experience with Medicare elections, transaction codes, and reconciliation operations is an advantage.
Two years of experience managing Late Enrollment Penalties (LEP) for Medicare Advantage Prescription Drug (MAPD) enrollees is preferred.
Familiarity with Centers for Medicare & Medicaid Services (CMS) tools and resources, particularly the Medicare Advantage Prescription Drug System (MARx), is highly desirable.
At least one year of experience with system testing or user acceptance testing (UAT) is preferred.
Previous experience developing and delivering employee training sessions is an advantage.
Good understanding of healthcare insurance enrollment processes, Medicare eligibility requirements, and related administrative procedures.
Working knowledge of administrative and clerical systems, including document processing, data entry, file management, and record maintenance.
Proficiency in Microsoft Office applications, particularly Outlook, Word, Excel, and Access, as well as experience navigating multiple software platforms simultaneously. Familiarity with EPIC or similar healthcare information systems is beneficial.
Strong analytical and critical-thinking skills, with the ability to identify discrepancies, follow established guidelines, and resolve enrollment issues efficiently.
Exceptional attention to detail, organizational skills, and the ability to manage multiple tasks while maintaining accuracy and meeting deadlines.
Excellent written and verbal communication skills, combined with strong interpersonal abilities, professional telephone etiquette, and a customer-focused approach.
Ability to work independently, follow instructions, adapt to changing priorities, and collaborate effectively with colleagues and external stakeholders.
Willingness to participate in required training and continuously develop knowledge of Medicare enrollment procedures and systems.
Ability to remain seated and work at a computer for extended periods in a standard office or remote working environment.
Benefits:
Full-time remote working arrangement within the United States.
40-hour workweek.
Opportunity to contribute to the development and improvement of innovative healthcare enrollment services.
Exposure to Medicare enrollment operations, eligibility management, and healthcare administration.
Opportunities to develop expertise in Medicare systems, CMS resources, and enrollment procedures.
Professional development through ongoing training and participation in system implementation and testing projects.
Collaborative working environment with opportunities to contribute to operational improvements and annual enrollment planning.
Opportunity to develop training, coordination, and process improvement skills.
Salary, healthcare coverage, retirement benefits, paid time off, and additional perks were not specified in the original job posting and should be confirmed with the hiring team.