[Hiring] Enrollment Specialist I/II/III/IV (Government Programs: CHP/QHP- Multiple Positions Available) @company

Role Description

Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations, the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation’s enrollment regulations, Underwriting Guidelines, and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member, and group administrator inquiries for all product lines.

• Inquiries are received by telephone, email, written inquiries, lobby walk-in customers, and through on-site visits with an employer group.
• The B version of this role will require the individual to be on the phone regularly.

Essential Primary Responsibilities/Accountabilities:

Level I:

• Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations.
• Maintain communication with Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, Customer Care, and external Customers, groups, or Brokers.
• Responsible for the enrollment of new groups, renewals, new member, and member movement.
• Prepare, process, and maintain all member enrollments utilizing multiple Health Plan enrollment systems.
• Review and assess member enrollment activity and associated documents for accuracy.
• Research, interpret, and respond to inquiries from internal and external customers, business partners, brokers, consultants, and groups.
• Review, validate, and update transaction errors from all member level electronic and paper sources.
• Identify issues and respond to all work items brought forward.
• Prioritize aged and Performance Guarantee Transactions.
• Attend provided/necessary training and participate in meetings.
• Execute quality service to external and internal customers.
• Maintain high regard for member privacy in accordance with corporate policies.
• Regular and reliable attendance is expected and required.
• Perform other functions as assigned by management.

Level II:

• Prepare, process, and maintain all group enrollment utilizing multiple Health Plan enrollment systems.
• Handle Designated Record Set (DRS) requests and may serve as a point person for the Account Service team.
• Adjust or triage enrollment for subscriber additions, deletions, and changes.
• Act as a resource to support and/or cross-train other team members.
• Identify issues, patterns, and/or trends affecting compliance and customer satisfaction.
• Assist in creating and/or updating operating manuals and/or Desk Level Procedures (DLP’s).
• Staff the Enrollment phone lines to resolve inbound telephone inquiries.

Level III:

• Proficient in most inventory areas and operating systems.
• Mentor and collaborate with others on the team.
• Serve as subject matter expert for the department.
• Process enrollment activities for complex accounts.
• Research, respond, and resolve eligibility inquiries.
• May assist with system releases and production validation.

Level IV:

• Create test cases and test processes for new products.
• Research complex cases to identify root cause and recommend resolution.
• Responsible for complex and/or sensitive cases.
• Serve as department representative on corporate projects.

Qualifications

• Level I: Completed High School Diploma or Equivalent.
• Minimum of two (2) years health insurance or related operations work experience preferred.
• Solid written and verbal communication skills.
• Proven organizational, analytical, and time management skills.
• Basic Computer proficiency, including experience in Microsoft Office Suite.
• Attention to detail and accuracy.
• Ability to multi-task and efficiently resolve customer concerns.
• B Version: Ability to actively listen to customers while taking notes.

• Level II: Minimum of three (3) years health insurance or related operations work experience preferred.
• Rating of “Performing” or above for minimally 12 months.
• Organizational, reasoning, and problem-solving skills.
• Takes accountability and ownership of issues with minimal supervision.

• Level III: Minimum of four (4) years health insurance or related operations work experience preferred.
• Must have strong written and verbal communication skills.
• Strong Computer proficiency, including experience in Microsoft Office Suite (Excel).
• Rating of “Performing” or above for minimally 12 months.

• Level IV: Minimum of five (5) years health insurance or related operations work experience preferred.
• Rating of “Performing” or above for minimally 12 months.
• Self-sufficient in resolving complex & escalated issues.

Requirements

• Ability to complete work in a traditional office environment under fluorescent lighting.
• Ability to arrive on time at work and as scheduled.
• Ability to meet minimum performance metrics.
• Ability to orally communicate.
• Must be able to function while sitting at a desk for 3 or more hours at a time.
• Must be able to travel across the enterprise.
• Ability to work in a home office for continuous periods of time for business continuity.

Benefits

• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.

Company Description

Equal Opportunity Employer

Compensation Range(s):

• Level I: Grade N2: Minimum: $20.00 - Maximum: $23.89
• Level II: Grade N3: Minimum: $20.00 - Maximum: $26.90
• Level III: Grade N4: Minimum: $20.00 - Maximum: $30.76
• Level IV: Grade N5: Minimum: $20.02 - Maximum: $33.03

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill, and education as they relate to the position’s minimum qualifications.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.