Enrollment Services - Enrollment Specialist - Commercial

CommunityCare•Tulsa, OK

16h

About The Position

The Enrollment Specialist is responsible for processing advanced commercial enrollment and membership transactions, including report review, transaction reconciliation, renewal and PCP routes, new group audits, system updates, correspondence, notices, prior coverage requests, ID card and output audits, and HICS case resolution. The role maintains policies, procedures, and process documentation while following service level agreements, audit-reviewed processes, and applicable regulatory guidance to support timely, accurate, and compliant enrollment operations.

Requirements

Strong oral and written communication skills.
Self-motivated, able to handle multiple tasks, and able to work with minimal supervision.
Strong organizational skills.
Ability to work effectively with personnel at various levels.
High attention to detail.
Successful completion of a Health Care Sanctions background check.
Proficiency in Microsoft Office applications.
High school diploma or equivalency.
A minimum of three years working in an administrative function for a health care institution, insurance company, or medical group is preferred.

Nice To Haves

A minimum of three years working in an administrative function for a health care institution, insurance company, or medical group.

Responsibilities

Process advanced employer group enrollment and membership transactions, and prepare and audit New Group, Provider, and renewal routes.
Review enrollment reports to identify required system updates, corrections, reconciliations, or escalations.
Reconcile enrollment transactions across systems, reports, source documentation, and membership records.
Administer renewal routes, PCP routes, and new group audits to support employer group setup, renewal processing, and membership maintenance.
Create, review, and generate enrollment-related correspondence, notices, prior coverage requests, and other member or group communications.
Audit ID cards, correspondence, and related output files before vendor release or distribution.
Research, document, and resolve HICS cases related to Marketplace enrollment.
Perform system updates related to transactional activity, report findings, renewals, group changes, and approved membership corrections.
Review, maintain, and update departmental policies, procedures, and process documentation.
Adhere to service level agreements, internal audit-reviewed processes, and applicable state and federal regulatory guidance.
Perform other job-related duties as required or assigned.