Medicare Enrollment Specialist II

Overview

HealthEdge ® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge .com.

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently.  Through member and provider touchpoints with less friction, we have created real impact for members.

UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

UST HealthProof is looking for an Enrollment Specialist II, reporting to the Enrollment Manager. The Enrollment Specialist II is responsible for ensuring accurate enrollment including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. The role is also responsible for reconciling and correcting enrollment-related issues by building case files that are sent to the CMS Contractor for approval and resolution.

As an Enrollment Specialist II at UST HealthProof, this is your opportunity to

- Be responsible for preparing, processing, and maintaining enrollment and disenrollment requests

- Be responsible to verify and maintain all applicable eligibility requirements

- Be responsible to review and process CMS transactions

- Be responsible for reviewing Medicaid eligibility and completing verification processes

- Be responsible to resolve enrollment system rejections based on regulatory and client specified guidelines

- Be responsible to reconcile membership reports as required by CMS

- Be accountable to attend and successfully complete the trainings scheduled by the client and employer

- Mentor junior members of the team

- Collaborate with other team members on special projects; special projects can include process documentation development, training, quality reviews for the client(s), or any other project as determined by management

- Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality

- Participate in projects as assigned by management

- Perform other duties as assigned

You bring:

- High school degree required

- 3-5 years of professional experience in processing Medicare enrollment transactions

- A thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines; Medicaid enrollment experience a plus

- Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions

- Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way

- Willingness to learn

- Team collaborator

- Strong work ethic

For this role, we value:

- The ability to adapt quickly to a challenging environment

- A self-starter and quick learner

- Ability to collaborate

Geographic Responsibility: Remote, US