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Salary: USD 50,000 - 56,000 / annual
HealthEdge, an AI-powered operational infrastructure provider for health insurance companies, is seeking a Senior Enrollment Specialist to join UST HealthProof, a fast-paced division focused on reshaping health insurance through modernized, cloud-based core administration solutions.
In this role, you will be responsible for ensuring accurate enrollment, 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 for CMS Contractor review and approval. Key responsibilities include:
• 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
• Mentor junior team members
• Collaborate on special projects including process documentation, training, and quality reviews
• Maintain appropriate communication with management to address issues and ensure case accuracy
• Perform other duties as assigned
You will report to the Enrollment Manager and work in a supportive environment that nurtures individual growth. The role requires working across multiple time zones in a remote environment, with occasional travel dependent on company needs.
REQUIREMENTS:
• 5+ years of professional experience processing Medicare enrollment transactions
• Thorough understanding of Medicare Advantage products, CMS transaction files, and enrollment-related guidelines
• Experience with CMS interfaces and systems for managing Medicare Advantage enrollment and billing functions
• Medicaid knowledge is a plus
• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operational reports in a structured way
• High school degree required
• Willingness to learn, team collaboration skills, and strong work ethic
• Ability to adapt quickly to challenging environments
• Self-starter and quick learner mentality
