Commercial Enrollment Specialist II

Accountabilities: Prepare, process, and maintain member enrollment and disenrollment requests, ensuring accuracy and timely completion. Verify and maintain applicable eligibility requirements in accordance with relevant regulations and established procedures. Review and process CMS transactions while ensuring compliance with Medicare Advantage enrollment guidelines. Review Medicaid eligibility and complete the required verification processes where applicable. Investigate and resolve enrollment system rejections in accordance with regulatory requirements and client-specific guidelines. Research and resolve enrollment and billing discrepancies, maintaining accurate member data and supporting appropriate corrections. Build and maintain case files for enrollment-related issues requiring submission to the relevant CMS contractor for review, approval, and resolution. Reconcile membership reports as required by CMS and analyze enrollment data to identify discrepancies and support accurate reporting. Monitor operational performance indicators, including service-level agreements (SLAs) and key performance indicators (KPIs), and present findings in a structured, clear manner. Complete all required training provided by the employer and client to maintain current knowledge and meet performance expectations. Mentor junior team members, share knowledge, and contribute to a collaborative and productive working environment. Participate in special projects, including process documentation, team training, quality reviews, and other initiatives assigned by management. Maintain regular communication with management regarding issues, concerns, case accuracy, and quality improvement opportunities. Perform additional duties and support projects as assigned. Requirements: High school diploma or equivalent required. Three to five years of professional experience processing Medicare enrollment transactions. Thorough understanding of Medicare Advantage products, CMS transaction files, and applicable enrollment rules and guidelines. Experience using CMS interfaces and systems to manage Medicare Advantage enrollment and billing functions. Experience with enrollment reconciliation, discrepancy resolution, and maintaining accurate member information. Ability to analyze enrollment reconciliation data, evaluate operational performance, and prepare reports on SLAs, KPIs, and other relevant metrics. Strong analytical and problem-solving skills, with the ability to present findings clearly and in a structured format. Excellent attention to detail and a commitment to accuracy, quality, and regulatory compliance. Strong communication and interpersonal skills, including the ability to collaborate effectively with colleagues and management. Willingness to learn, adapt quickly to changing priorities, and complete required training. Self-motivated, proactive, and able to work effectively in a challenging, fast-paced environment. Strong work ethic, accountability, and a team-oriented mindset. Ability to work remotely across multiple time zones and remain productive during extended periods of computer-based work. Preferred: Experience with Medicaid enrollment and eligibility verification. Benefits: Annual base salary: $40,000–$44,000, with final compensation determined by skills, experience, qualifications, and education. Full-time, permanent employment. Fully remote work arrangement within the United States. Opportunity to develop expertise in Medicare Advantage enrollment, CMS processes, and healthcare operations. Opportunities to mentor junior colleagues and participate in training, quality improvement, and process documentation initiatives. Potential travel depending on business needs. Candidates may be required to complete a pre-employment criminal background check. Specific healthcare coverage, retirement benefits, paid time off, and other employee perks are not detailed in the available job posting.