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UST HealthProof, part of HealthEdge, is seeking an Enrollment Team Lead to support the Enrollment Operations Business Unit. This role reports to the Enrollment Manager and is responsible for overseeing both onshore and offshore enrollment specialists while managing critical enrollment processes.
Key responsibilities include:
- Managing and processing discrepancy queues, RPC (Reconciliation Processing Center), LEP (Limited English Proficiency), briefcases, and JIRA tickets
- Assisting with audits, overseeing correspondence submissions, and generating client reports
- Maintaining inboxes and delegating tasks to team members
- Navigating and interpreting CMS (Centers for Medicare & Medicaid Services) regulations and guidance in accordance with the CMS Manual System
- Assisting with development and review of policies and procedures to ensure compliance with CMS regulations
- Researching, analyzing, and disseminating new CMS guidance to cross-functional teams and stakeholders
- Partnering with business units to develop and improve workflows and business processes
- Coaching and training onshore and offshore personnel
- Recommending process improvements to support SLA (Service Level Agreement) targets
- Serving as a Lead Enrollment Subject Matter Expert (SME)
- Writing and maintaining enrollment-related documentation
Required qualifications:
- 7+ years in a related field, with expertise in two areas such as process improvement, project planning, healthcare economics, healthcare policy, statistical modeling, business analysis, or business management
- Thorough understanding of Medicare Advantage products, CMS transaction files, and enrollment-related guidelines
- Experience with CMS interfaces and systems for Medicare Advantage enrollment and billing
- Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and operational metrics
- Bachelor's degree in a related field (relevant combination of education and experience may substitute)
- Proficiency with standard PC applications (Access, Excel, Word, PowerPoint)
- Strong collaboration, creativity, flexibility, and work ethic
- Ability to work across multiple time zones in a remote environment
HealthEdge offers AI-powered operational infrastructure for health insurance companies, helping health plans modernize operations and reduce administrative costs while improving member experiences.
