Commercial Enrollment Specialist II

📋 Description

• Prepare, process, and maintain member enrollment and disenrollment requests, ensuring accuracy and
• Verify and maintain applicable eligibility requirements in accordance with relevant regulations and
• Review and process CMS transactions while ensuring compliance with Medicare Advantage enrollment
• Review Medicaid eligibility and complete the required verification processes where applicable.
• Investigate and resolve enrollment system rejections in accordance with regulatory requirements and
• Research and resolve enrollment and billing discrepancies, maintaining accurate member data and

🎯 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
• Experience using CMS interfaces and systems to manage Medicare Advantage enrollment and billing
• Experience with enrollment reconciliation, discrepancy resolution, and maintaining accurate member
• Ability to analyze enrollment reconciliation data, evaluate operational performance, and prepare

🎁 Benefits

• Annual base salary: $40,000–$44,000, with final compensation determined by skills, experience
• Full-time, permanent employment.
• Fully remote work arrangement within the United States.
• Opportunity to develop expertise in Medicare Advantage enrollment, CMS processes, and healthcare
• Opportunities to mentor junior colleagues and participate in training, quality improvement, and
• Potential travel depending on business needs.