Enrollment Specialist I/II/III/IV

Excellus BCBS • Rochester, NY

1d • $20 - $33

About The Position

Under the direction of assigned management, and after successfully completing all phases of training, the Enrollment Specialist performs enrollment processing and servicing in accordance with HIPAA regulations, Health Plan Operations enrollment regulations, underwriting guidelines, and applicable government regulations. The role focuses on prompt, accurate, and efficient service for broker, member, and group administrator inquiries across all product lines. Inquiries may arrive by telephone, email, written correspondence, lobby walk-ins, or on-site employer group visits. The B version of the role regularly staffs phone lines.

Responsibilities vary by level. Level I handles subscriber enrollment operations for government programs and small, mid-sized, and large employer groups. Level II adds group enrollment processing, Designated Record Set requests, phone inquiries, process improvement, and broader inventory knowledge. Level III adds expertise across most inventory areas, complex account processing, mentoring, subject-matter expertise, and possible system-release validation. Level IV adds complex and sensitive case resolution, test-case development, procedure documentation, participation in corporate projects and cross-functional groups, and advice to project teams and leadership.

The role requires accurate and timely work, regulatory and privacy compliance, customer service, and meeting productivity, accuracy, compliance, member-touchpoint, and CMS processing-timeframe targets. Work is performed in an office environment and may also be performed from a home office for business continuity. Travel across the enterprise is required.

Requirements

• Level I: High school diploma or equivalent.
• Level I: Two years of health insurance or related operations work experience is preferred, with demonstrated ability to perform the position's requirements and responsibilities.
• Level II: Three years of health insurance or related operations work experience is preferred; a rating of “Performing” or above for at least 12 months is required.
• Level III: Four years of health insurance or related operations work experience is preferred; a rating of “Performing” or above for at least 12 months is required.
• Level IV: Five years of health insurance or related operations work experience is preferred; a rating of “Performing” or above for at least 12 months is required.
• Level I: Solid written and verbal communication, organizational, analytical, and time-management skills.
• Level I: Basic computer proficiency, including Microsoft Office Suite; attention to detail and accuracy; and ability to multitask while navigating computer screens, typing inquiry documentation, and resolving customer concerns.
• Level II: Organizational, reasoning, and problem-solving skills; accountability and ownership of issues and resolutions with minimal supervision; and initiative to recognize opportunities within the team.
• Level III: Strong written and verbal communication and computer proficiency, including Microsoft Office Suite and Excel; ability to mentor and support new hires and peers and to handle advanced problem-solving tasks.
• Level IV: Ability to resolve complex and escalated issues independently and lead management-assigned tasks requiring advanced problem-solving across multiple areas.
• B version: Ability to actively listen while simultaneously taking notes and to be on the phone regularly.
• Ability to complete work in a traditional office environment under fluorescent lighting and arrive on time as scheduled.
• Ability to meet minimum performance metrics and communicate orally.
• Ability to sit at a desk and view a computer while using a keyboard and mouse for three or more hours at a time.
• Ability to travel across the enterprise.
• Ability to work in a home office for continuous periods for business continuity.

Nice To Haves

• Level I: Two years of health insurance or related operations work experience.
• Level II: Three years of health insurance or related operations work experience.
• Level III: Four years of health insurance or related operations work experience.
• Level IV: Five years of health insurance or related operations work experience.

Responsibilities

• Process and service subscriber enrollments for government programs and small, mid-sized, and large employer groups.
• Maintain communication with internal partners, including Enrollment Management, Account Services, Sales, Finance/Underwriting, Claims, and Customer Care, and interact with external customers, groups, and brokers as needed.
• Enroll new groups, renewals, new members, and member movements; maintain enrollment and member information across multiple systems.
• Process benefit changes, cancellations, reinstatements, and other enrollment transactions using sales, marketplace, and enrollment systems.
• Review enrollment activity and supporting documents for accuracy and compliance with applicable processing regulations and guidelines.
• Research, interpret, and respond to inquiries from internal and external customers, business partners, brokers, consultants, and groups.
• Run pre-built reports and review, validate, and update transaction errors from electronic and paper sources affecting eligibility interfaces.
• Identify and address work items and inquiries within department service-level agreements; prioritize aged and Performance Guarantee transactions to meet established metrics.
• Maintain processing knowledge and accuracy across assigned inventory areas, attend training and meetings, and share information with the team.
• Meet productivity and accuracy metrics, compliance and member touchpoint measures, and CMS processing timeframes while protecting member privacy.
• At Level II, process and maintain group enrollments and group information, handle Designated Record Set requests, triage enrollment adjustments, request additional information when needed, cross-train team members, and staff enrollment phone lines.
• At Level II, identify patterns affecting compliance, customer satisfaction, or system performance; recommend and initiate process improvements; and assist with operating manuals and Desk Level Procedures.
• At Level III, mentor and collaborate with teammates, serve as a department subject-matter expert, cross-train across tasks, remove operational barriers, process complex accounts, prioritize urgent cases, resolve eligibility inquiries, and possibly assist with system releases and production validation.
• At Level IV, create test cases, test processes, document procedures for new products and work efforts, and possibly participate in end-user testing.
• At Level IV, research complex cases to determine root causes and implement resolutions, handle complex or sensitive cases, represent the department on corporate projects and cross-functional work groups, and advise project teams and leadership on productivity and quality implications.
• Perform other functions assigned by management.

Benefits

• Group health insurance and/or dental insurance may be included in the total rewards package.
• Retirement plan may be included in the total rewards package.
• Wellness program may be included in the total rewards package.
• Paid time away from work may be included in the total rewards package.
• Paid holidays may be included in the total rewards package.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED