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Salary: USD 40,000 - 44,000 / annual
HealthEdge is an AI-powered operational infrastructure platform serving health insurance companies. UST HealthProof, part of HealthEdge, is seeking a Commercial Enrollment Specialist II to join a fast-paced, growing team reshaping health insurance through modernized cloud-based administration and reduced administrative costs.
In this role, you will be responsible for ensuring accurate enrollment, including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. You will reconcile and correct enrollment-related issues by building case files sent to CMS Contractors for approval and resolution. Key responsibilities include:
• Preparing, processing, and maintaining enrollment and disenrollment requests
• Verifying and maintaining all applicable eligibility requirements
• Reviewing and processing CMS transactions
• Reviewing Medicaid eligibility and completing verification processes
• Resolving enrollment system rejections based on regulatory and client-specified guidelines
• Reconciling membership reports as required by CMS
• Attending and successfully completing scheduled trainings
• Mentoring junior team members
• Collaborating on special projects including process documentation, training, and quality reviews
• Maintaining appropriate communication with management to address issues and ensure case accuracy
• Performing other duties as assigned
You will work across multiple time zones in a remote environment, with long periods at a computer using video technology. The role reports to the Enrollment Manager and offers opportunity to grow within a company led by leaders with strong health plan and technology backgrounds.
REQUIREMENTS:
• High school degree required
• 3–5 years of professional experience processing Medicare enrollment transactions
• Thorough understanding of Medicare Advantage products, CMS transaction files, and corresponding enrollment-related guidelines
• 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 in a structured way
• Medicaid enrollment experience a plus
• Willingness to learn, team collaboration, and strong work ethic
• Ability to adapt quickly, self-starter, quick learner, and collaborative mindset
