Enrollment Specialist I/II/III/IV

company•Village of Johnson City, NY

3d•$20 - $33

About The Position

Under the direction of Assigned Management, and after successful completion of training, the Enrollment Specialist performs enrollment processing and servicing in accordance with HIPAA requirements, Health Plan Operation 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 product lines. Inquiries may come by telephone, email, written correspondence, lobby walk-ins, or on-site employer group visits. The B version of the role requires regular phone work. Responsibilities vary by level. Level I handles subscriber enrollment operations, member enrollment activity, customer inquiries, transaction errors, and assigned inventory areas. Level II adds group enrollment processing, Designated Record Set requests, enrollment adjustments, staff phone-line coverage, and support for or cross-training of teammates. Level III adds expertise across most inventory areas, mentoring, complex account processing, eligibility research and resolution, and possible support for system releases. Level IV adds test-case creation and process testing, procedures for new products and work, complex case resolution, and representation of the department on corporate projects and cross-functional work groups. The position requires maintaining member privacy, meeting service, productivity, accuracy, compliance, and processing-time expectations, and supporting the Lifetime Healthcare Companies’ mission, values, and Code of Conduct. The physical requirements include working in a traditional office environment and the ability to work in a home office for business continuity. Remote work may be possible on a case-by-case basis.

Requirements

High school diploma or equivalent.
Level I: Two years of health insurance or related operations work experience is preferred.
Level II: Three years of health insurance or related operations work experience is preferred, along with a rating of “Performing” or above for at least 12 months.
Level III: Four years of health insurance or related operations work experience is preferred, along with a rating of “Performing” or above for at least 12 months.
Level IV: Five years of health insurance or related operations work experience is preferred, along with a rating of “Performing” or above for at least 12 months.
Solid written and verbal communication skills; strong written and verbal communication skills are specified at Level III.
Organizational, analytical, and time-management skills.
Basic computer proficiency, including Microsoft Office Suite; strong computer proficiency, including Excel, is specified at Level III.
Attention to detail and accuracy.
Ability to multitask while resolving customer concerns, navigating computer screens, and documenting inquiries.
Level II: Organizational, reasoning, and problem-solving skills; accountability and ownership of issues with minimal supervision; and initiative to identify opportunities within the team.
Level III: Ability to mentor and support new hires and peers and assist with tasks requiring advanced problem-solving skills.
Level IV: Ability to independently resolve complex and escalated issues and lead tasks requiring advanced problem-solving across multiple areas.
For the B version at any level: Ability to actively listen to customers while taking notes and to be on the phone regularly.
Ability to arrive at work on time as scheduled and meet minimum performance metrics.
Ability to orally communicate and work while seated at a desk viewing a computer and using a keyboard and mouse for three or more hours at a time.
Ability to travel across the enterprise and work in a home office for continuous periods for business continuity.

Responsibilities

Process and service enrollment activity in accordance with HIPAA requirements, Health Plan Operation enrollment regulations, underwriting guidelines, and applicable government regulations.
Support Government Programs and Small, Mid, and Large Employer Group Subscriber Enrollment Operations.
Communicate with internal partners, including Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, and Customer Care, and with external customers, groups, and brokers.
Enroll new groups and members, process renewals and member movements, and maintain member information, benefit changes, cancellations, and reinstatements in multiple enrollment systems.
Review enrollment activity and associated documents for accuracy and compliance with processing regulations and guidelines.
Research, interpret, and respond to inquiries from internal and external customers, business partners, brokers, consultants, and groups regarding products, services, and policies.
Run pre-built reports and review, validate, and update transaction errors from member-level electronic and paper sources that affect eligibility interfaces.
Identify and respond to work items, meet department service-level agreements, and prioritize aged and Performance Guarantee Transactions according to established metrics.
Maintain the knowledge and accuracy required for assigned inventory areas and participate in training and team meetings.
Meet productivity, accuracy, compliance, member touchpoint, and CMS processing-timeframe expectations while providing quality service.
Maintain member privacy and adhere to corporate privacy policies, procedures, the Corporate Code of Conduct, and company values.
At Level II, process group enrollment and group information, handle Designated Record Set requests, adjust or triage enrollment changes, request additional information, support or cross-train teammates, and staff Enrollment phone lines.
At Level III, serve as a subject matter expert, mentor and collaborate with teammates, process complex accounts, reprioritize urgent or complex cases, resolve eligibility inquiries, and potentially assist with system releases and production validation.
At Level IV, create test cases, test processes, document procedures for new products and work efforts, research and resolve complex or sensitive cases, and represent the department on corporate projects and cross-functional work groups.
Perform other functions as assigned by management.